The British Healthcare Trades Association (BHTA) and Driving Mobility have published interim guidance for BHTA members about the UK Government’s spring 2024 update called ‘Using mobility scooters and powered wheelchairs’.
This interim guidance has been published by the BHTA and Driving Mobility following a notable (and somewhat confusing) update to the government document around “not in a class” mobility scooters and powerchairs.
“Not in a class” mobility scooters and powerchairs are a new class of mobility vehicle that was introduced in the government’s spring 2024 update. This new class has raised a lot of questions and concerns by BHTA members.
BHTA and Driving Mobility’s interim guidance is designed to help member companies understand the latest government update and outline clearly what the new ‘not in a class’ classification means.
This is followed by a series of questions (as identified by the by BHTA, Driving Mobility, and several member companies) that seek clarification from the government following its most recent update to ‘Using mobility scooters and powered wheelchairs’. The guidance will be updated in due course as the BHTA and Driving Mobility seek answers from relevant government stakeholders.
Download the BHTA guidance document in full here.
Written by experts from the BHTA First Aid Medical Equipment (FAME) and Defibrillator Section.
Download the BHTA guidance document as a PDF here.
Written by experts from the BHTA Beds and Support Surfaces and Pressure Care and Seating Sections.
The ISO 20342 series of standards covers various aspects of safety, performance, and technical information relating to mattresses and related products, products described in the standards as “Assistive Products for Tissue Integrity” or “APTIs”. Part 1 of the series covers General Requirements, and these are applicable to all APTIs. The information set out within the general requirements standard is intended to help ensure the safety of users.
The devices covered by this standard include all pressure redistributing mattresses and overlays manufactured using a range of materials including foam, gel, air, and foam in combination with air (i.e. hybrid mattresses). Products within the scope of this standard also include all reactive (non-powered) and active (powered) mattresses and overlays. This standard does NOT include wheelchair cushions.
Aspects relating directly towards the clinical efficacy of a product (and therefore the safety-related properties in prevention or management of pressure injuries, for example) are not addressed in this standard, but are topics covered by tests prescribed in other parts of the ISO 20342 series.
The aim of this article is to give the reader a feel as to why they should be aware of the standard’s content and provide an overview of what the standard covers in depth, and therefore its importance in the design, selection, and use of an APTI.
BS EN ISO 20342-1 is the first mattress and related device international safety standard. It sets the minimum threshold a device should reach in order to protect the safety of users.
BS EN ISO 20342-1 covers the key safety elements from an APTI-specific standpoint. These include management of potential hazards and addresses specific areas of mechanical, electrical, and materials safety. Table 1 contains a summary of the areas covered by the standard.
| Clause | Content |
|---|---|
| 4. General requirements and safety | 4.1 General; 4.2 Intended use; 4.3 Risk management; 4.4 Usability; 4.5 Design controls; 4.6 Clinical evaluation; 4.7 Foreseeable misuse; 4.8 Test conditions; 4.9 Lifting and carrying means |
| 5. Safety requirements | 5.1 Information supplied by the manufacturer; 5.2 APTI that can be dismantled; 5.3 Resistance to corrosion; 5.4 Noise and vibration; 5.5 Sound audible acoustic energy; 5.6 Default indicators; 5.7 Feedback |
| 6. Flammability | 6.1 General; 6.2 Flammability; 6.3 Moulded parts used as enclosures for electrical equipment |
| 7. Mechanical safety | 7.1 Prevention of traps; 7.2 Moving and folding parts; 7.3 V-shaped openings; 7.4 Surfaces, corners, edges and protruding parts; 7.5 Folding and adjusting mechanisms; 7.6 Instability hazard; 7.7 Temperature of parts in contact with skin; Ergonomic principles; Additional considerations |
| 8. Safety of electrical equipment | 8.1 General; 8.2 Electromagnetic compatibility; 8.3 Liquid ingress; 8.4 Interruption of power supply; 8.5 Hold to run activation; 8.6 Emergency stop functions |
| 9. Biocompatibility | 9.1 Biocompatibility and toxicity; 9.2 Animal tissue |
| 10. Contamination | 10.1 Liquid ingress; 10.2 Cleaning and disinfection; 10.3 Cross infection and microbial contamination |
| Annex A. General Information | A.1 General; A.2 Design controls; A.3 Packaging; A.4 Noise and vibration; A.5 Flammability; A.6 Ergonomic principles; A.7 (EMC) immunity; A.8 Cleaning and disinfection; A.9 Moisture vapour permeability/microclimate management |
| Annex B. Environmental and consumer related guidance | Covers Hazardous Substances in an APTI. B.1 General; B.2 All materials; B.3 Textiles; B.4 Plastic materials; B.5 Metals; B.6 Wooden parts |
| Annex C. Periodic inspection |
This standard clearly sets out the expected safety requirements for all mattress surface devices, irrespective of which medical device classification they fall into. To deliver safe, effective, harm-free care to patients, it is not unreasonable to assume the use of devices which meet the required level of safety and do not inadvertently introduce any additional risks to users.
With pressure ulcers recognised as a preventable harm and pressure ulcer incidence metrics typically reported at board meetings as a key indicator or care quality, it is prudent for providers to use products that meet the required levels of safety.
Clinicians will benefit from clear statements around the intended use, intended users, and any device claims around performance and safety, including minimum and maximum user weight on the device.
Furthermore, supporting documents, such as the clinical evaluation and instructions for use, will give additional information about the suitability of the device for local patients/residents. Requesting relevant evidence as part of a tender process will help ensure that claims of device performance are substantiated with appropriate levels of evidence and supporting documentation. This can be particularly helpful when looking to substantiate claims for self-certified, Class I medical devices, which are otherwise externally-unregulated devices.
Where manufacturers’ products align with this standard, it demonstrates that the manufacturers are seeking to attain minimum levels of device safety and that their claims around device performance can be supported by suitable data and evidence, thereby giving clinicians peace of mind when prescribing the products for patients.
Medical device manufacturers typically strive to deliver the safest, most effective products to the market. Since elements of BS EN ISO 20342-1 will apply to every APTI sold in the UK it would be a concern to understand why a manufacturer would not want their products to comply with this standard.
Healthcare providers can help encourage uptake of these standards by listing compliance as a prerequisite on mattress tender submissions. If manufacturers need to comply with specific elements of the ISO 20342 series of standards (e.g. Part 1, General Requirements) to be considered for the tender, this would greatly encourage this area of the medical device industry to meet the requirements for BS EN ISO 20342-1:2002.
BS EN ISO 20342-1:2022 – TC | 31 Aug 2022 | BSI Knowledge (bsigroup.com)
For a broader background to the ISO 20342 series of APTI standards, see the BHTA article: ‘New standards for testing mattresses and related products – An Introduction’
With funding in the NHS and hospital discharges creating pressure on health and care services on a daily basis, it is possible to find equipment solutions yourself with help from British Healthcare Trades Association (BHTA) members.
This guidance article is designed to advise consumers about the options available when self-funding (paying for equipment yourself) that can help you or a family member return home quicker and maintain an independent life.
Some independent living products are less expensive than you think and can make all the difference between a longer stay in hospital or a quicker discharge. Accepting using a product that improves your independence can also prevent the need to go to a hospital in the first place.
Member companies have skilled and trained staff across the UK, who are already working closely with the NHS and other healthcare professionals and are uniquely placed to help.
Take the first steps by talking to your local BHTA retailer and find out about the products that can assist you to be independent and mobile.
We have put products you might need into room settings to help guide you through the types of things you might want to consider to help you around your home. There are many products that are affordable to make things easier for you.
If you have arthritis or have had a stroke, there is shaped handle cutlery that gives you a better grip to help you eat. They are easy to take with you when eating out, so you can enjoy your meals without having to ask for assistance to have food cut up. If you prefer your own cutlery, foam grips can easily slip on to give you a better grip.
Cups with lids and two handles, plates with raised edges, together with non-slip mats can help you eat. Other useful items to consider are openers for jars and tins, cleaning and cooking equipment, a wheeled trolley, or a one-handed tray, which will enable you to move food from the kitchen to the table.
That designer sofa that you bought years ago can suddenly be too low if you’re struggling to sit down or stand back up. You can choose block raisers, making it easier to get on and off, but if this is a struggle you can choose a high-backed chair that can be tailored to your height.
If you need assistance all the way to standing, a gentle riser recliner chair with motors will lift you to a standing position at the touch of a button. Relaxing is the opposite flick of the controls. With a wide range of fabric, you can choose a chair to match close to your existing furniture.
As we get older, it’s not always easy to bend the knees to sit on the toilet, so there are many choices you can consider to improve the situation. A four-inch raised toilet seat on top of your existing toilet can help you to sit down without the help of a carer.
If you’re a bit unsteady and have balance issues, a toilet frame with seat can help you to get up and down easier. These can sometimes save having a commode in other rooms, such as the bedroom, but the choice is available to meet the different needs of everyone. Some commodes can have a dual function as a shower chair, giving the additional benefit of two ways of independent living.
Having a bath sometimes becomes more difficult when you are unable to lift yourself in and out and lift your legs over the side. Portable bath lifts can offer a solution. The bath lift sits in the bottom of your existing bath, and, once you have side transferred onto the seat, the battery-powered motor lowers you gently into the water to enable you to relax and wash. The advantage of a bath lift is that some are removable for other bath users in the home and can travel with you in the car if going away on holiday.
Another useful washing aid is a non-slip bathmat, designed to make bathing safe and create a secure environment.
If a bath is no longer an option, some BHTA members will be able to offer level access showers or a wet room, but these require specialist advice and assessments.
Handrails and bannisters down the side may just be the help you need to navigate your stairs, but when getting to your bedroom becomes too difficult you still have choices.
Stairlifts or through-floor lifts allow you to stay in your own home longer. It may seem like an expensive option, but compared to the cost of moving house or into a care home, this could be a better option to consider.
BHTA members have the knowledge and skills to advise you what your best solution is. They can help guide you through any grants that may be available.
Specialist profiling beds, rails, and pillows can make a difference to a great night’s sleep. If you have to spend more time in bed, profiling beds offer you multi-positioning allowing you to sit up, lie down, and help to redistribute pressure by the ease of changing position. There are plenty of choices you can make inside your home to make life easier and are all available through your local BHTA retailers and suppliers.
Sometimes you can manage to move around the home but going further afield can be another challenge. The next section demonstrates some of the choices you may wish to consider.
Walking can become more difficult and reduce the range you can travel in your local community or further afield. If you need a small amount of walking assistance, a rollator shopping trolley can offer you support when walking, and some have seats to allow you to rest when you need to.
Mobility scooters open up further choices depending on your aims, and a BHTA retailer will be able to advise you. A lightweight transportable scooter can be dismantled and put into the boot of your car for visits to other places and to take on holiday. These will offer a reduced battery range, as their size is smaller to make them easier to lift.
A mid-range scooter for use on the pavement offers bigger batteries, longer range, and better kerb climbing with larger wheels. These are ideal for getting to your local shops.
If you have been a car driver, the loss of a car may mean that you want to consider a mobility scooter for use in the road, allowing you to go further. These can go up to 8mph and may offer you the range to continue your adventures and go that bit further.
Help and advice is free from all BHTA member companies, all of which sign up to our Code of Practice, allowing you to buy with confidence.
Written by experts from the BHTA First Aid Medical Equipment (FAME) Section.
View and download this guidance as a PDF here.
Automated external defibrillators (AEDs) are vital life-saving devices and should be checked regularly to make sure they are ready to be used in an emergency.
Add these simple checks into your weekly routine, for example after checking your fire alarms and other safety systems, to ensure your device is ready to rescue.
1. Can you open the cabinet easily?
2. Is the AED missing?
3. Are the AED pads in date?
4. Is the AED showing low or no battery?
5. Is the AED showing an error?
Written by experts from the BHTA Stairlifts and Access Section.
View and download this guidance as a PDF here.
When looking to buy a reconditioned or second-hand stairlift, consider these six essential points:
1. The stairlift is being installed by a BHTA member company or a company with whose practices and policies you are comfortable.
2. An in-home assessment is made that takes account of the person(s) using the stairlift and the staircase in which it is to be fitted. A survey should be conducted as part of the sales purchase.
3. A warranty period and service cover are included. The stairlift should be installed with a callout number supplied. Check the engineer response time.
4. Stairlifts for curved staircases have unique needs. This means when you buy are conditioned stairlift for your curved staircase, the rails should be made to measure.
5. Consider the many factors that will influence the lifespan of a stairlift. These include age, appropriate usage, number of installations, and regular service.
6. An instruction manual should be supplied for the stairlift. Upon installation, a full user demonstration must be given.
Written by experts from the BHTA Beds and Support Surfaces and Pressure Care and Seating Sections.
A series of International Standards is being published encompassing the testing of mattresses and related products that are designed to be surfaces to interface with the body, to manage the health of the body’s skin tissues when lying down. These standards are being published in the ISO 20342 series.
The aim of this article is to highlight the importance and relevance of these standards to procurement, prescribers (clinicians/nurses), and healthcare providers. Each of these stakeholders will benefit from having a recognised ‘minimum standard’ of safety for these products.
In addition, these standards will also enable stakeholders, during a product selection process, to undertake a more meaningful comparison of important performance metrics, such as pressure redistribution, moisture vapour transfer rates, etc, across products. Some measures carry pass/fail criteria, while others provide a value along a scale where a higher value may be more beneficial for some individuals, whereas other people will be better off at the other end of a scale.
NOTE. The standards have been prepared by an ISO committee, but where they have been adopted in Europe, they have this added as EN in front of the ISO number, and where adopted in the UK, BS is added in front of the number e.g. BS EN ISO 20342-1. This lettering applies to the full standards, whereas the Technical Reports and Technical Specifications have CEN and PD prefixes instead of EN and BS respectively.
The standards have coined the acronym APTI, which stands for “Assistive Products for Tissue Integrity when lying down”. The scope of the ISO 20342 series includes devices that are intended to remain in situ during periods of lying and to prevent and/or treat pressure injuries. This encompasses a range of different lying support surfaces including mattresses, mattress overlays, and mattress coverings for pressure injury prevention mattresses.
In addition, these standards also cover assistive products primarily intended for tissue integrity both for changing a lying position, and for maintaining a lying position. This includes devices for changing position or direction of a person using sliding or turning techniques, where they are intended to be used on a person in a lying position and remain in situ as part of the lying support surface. Other product areas within the scope include positioning pillows, positioning cushions, and positioning systems, along with bedding such as draw sheets.
These devices are likely to include all pressure redistributing mattresses and overlays manufactured using a range of materials including foam, gel, air, and foam in combination with air (i.e. hybrid mattresses). These devices may be reactive (non-powered) or active (powered) mattresses and overlays.
This series does not apply to lying support surfaces used in combination with incubators or operating/surgical tables, nor to wheelchair seating products.
Medical devices are placed on the market with specific clinically related claims. The manufacturer has to justify these claims and also show that the product is safe and fit for purpose. Testing to, and passing, recognised standards is part of this process.
Historically, mattress manufacturers have typically used their own test methods to quantify and report on the key performance characteristics of their products, for example pressure reduction. Whist these metrics can help users understand the level of performance offered by one specific product, the significant variability between test methods, test equipment, and how the results are reported or presented by manufacturers typically precludes any meaningful comparison of the test results from different products.
This series of ISO 20342 standards, and the associated test methods described within them, are designed to enable stakeholders involved in mattress provision (i.e. clinicians, prescribers, compliance, procurement, medical engineering, etc.) a framework within which they can confirm device safety and compare relevant specific device performance characteristics across different support surfaces, without having to undertake their own internally-designed bench tests.
The standards set out a series of validated tests and ‘best practice’ for manufacturers to align with, where appropriate.
Where a manufacturer employs the standards, it demonstrates that they are seeking to attain the highest levels of device safety and that their claims around device performance can be supported by data from validated test methods.
When a healthcare provider goes out to tender for new mattresses, numerous devices are often considered simultaneously. It can be time-consuming and complex for the provider to assimilate the information supplied by the tendering manufacturers or suppliers and previously it has often been impossible to make meaningful comparisons between products from different manufacturers.
Because the standards describe detailed test processes utilising validated test methods, results from performance testing to ISO 20342 test methods can be tabulated, thereby permitting the same performance characteristics across products from different manufacturers to be compared directly with one another.
This enables the healthcare provider to perform an initial ‘desk-top’ comparison of various mattress device performance metrics which will help the provider determine which products to take forward to a local user evaluation with their staff and patients or residents.
The suite of ISO 20342 standards covers various aspects of device safety, performance, or technical information, including pressure redistribution, shear (horizontal stiffness) and microclimate. See Table 1 for a full listing of characteristics covered by the BS EN ISO 20342 standards.
Key:
SAFETY Standard = red
TECHNICAL Standard = yellow
PERFORMANCE Standard = green
| Standard Part | Standard Title (and coverage) | Published |
|---|---|---|
| BS EN ISO 20342-1:2022 | Assistive products for tissue integrity when lying down. General requirements (Principally broader safety elements – see separate BHTA report) | 2022 |
| PD CEN ISO/TR 20342-2 | Microclimate (Heat and moisture vapour dissipation at the skin and device interface) | TBC |
| BS EN ISO 20342-3 | Strength and impact (Tensile strength of materials, bursting strength/distension, seam/weld strength, carry handles, bottoming out, etc.) | TBC |
| BS EN ISO 20342-4 | Durability (Resistance to repetitive loading, ageing (drop test/lifespan test/wear and tear/loading and unloading, etc.) | TBC |
| BS EN ISO 20342-5 | Cleaning and disinfection (Test method to determine the resistance of waterproof coated textiles to liquid disinfectants and cleaning methods) | TBC |
| BS EN ISO 20342-6 | Horizontal stiffness (Shear) | TBC |
| PD CEN ISO/TR 20342-7:2022 | Assistive products for tissue integrity when lying down — Part 7: Foam properties, characteristics and performance. (Resilience; density; hardness; compression set; tensile strength; tear strength; air flow/permeability; resistance to fatigue; and microbial resistance) | 2022 |
| BS EN ISO 20342-8 | Pressure redistribution (Immersion, envelopment, and pressure relief) | TBC |
| BS EN ISO 20342-9 | Flammability (Resistance to ignition by a specified heat source e.g. a smouldering cigarette equivalent) | TBC |
| PD CEN ISO/TS 20342-10:2022 | Assistive products for tissue integrity when lying down. Guide to cleaning, disinfecting and care of polyurethane APTI covers. | 2022 |
The ISO 20342 series currently consists of ten published or in-preparation parts, however this is an ongoing programme of work within ISO and whilst the parts listed above cover the essential elements of safety and performance testing, it is likely that additional parts will be added in future.
No. Certain elements of the standards such as Part 1 General Requirements or Part 9 Flammability are likely to be relevant to almost all devices. However, it is envisaged that manufacturers will only perform testing in areas where they make a performance claim i.e. they will test against Part 8 if they are making claims of pressure relief or redistribution and Part 4 if they are making claims relating to durability.
Testing can be performed in house (where manufacturers have the capability of running the specified tests) or at an independent external test house. Some tenders may require the testing to have been carried out by test labs audited to ISO 17025.
Compliance with ISO standards is not generally mandatory, unless this is stipulated within a tender document, stipulated by local regulations, or where an ISO standard has been harmonised in the EU.
Most manufacturers are aware of the standards, and many of these manufacturers will be actively working towards ensuring that their products are compliant with the elements of the standard that apply to their devices. Where products have medical claims these products will be UKCA marked for GB and CE marked for Europe – the results of testing to the standards will be part of the Declaration of Conformity technical files.
Although the European Medical Device Regulation (MDR) and its predecessor the Medical Device Directive (MDD) (which is still in force in Great Britain), offer a broad framework for what is expected from a safe, compliant medical device, there has never been a clearly defined safety standard that is APTI specific and applies to every APTI irrespective of device classification.
ISO 20342-1:2022 is the first APTI specific safety standard. As well as providing some general guidance on certain aspects of device performance, it sets the minimum threshold a device (i.e., replacement mattress or mattress overlay) should reach in order to maximise the safety of users.
Due to the way in which the medical device classification rules are written, APTIs may either be designated as Class I medical devices or Class IIa medical devices.
Whilst APTIs classified as Class IIa devices are regulated by Independent Notified Bodies for CE marking (or GB Approved Bodies for UKCA marking), APTIs that are classified as Class I medical devices are self-certified by the legal manufacturer and are thus unregulated by an independent, external body.
The resulting differences in regulation and approach to APTI classification is less than ideal and can cause confusion in the marketplace, both from a manufacturer’s perspective and that of the healthcare provider and product prescriber.
Healthcare providers can help encourage uptake of these standards by listing compliance with them as a prerequisite on mattresses and related devices tender documentation. If manufacturers have to comply with specific elements of the standard (e.g. Part 1, General Requirements) to be considered for the tender, this would greatly encourage industry compliance with these requirements from the ISO 20342 series.
BS EN ISO 20342-1:2022 – TC | 31 Aug 2022 | BSI Knowledge
Guidance relating to this standard has been compiled by the BHTA in the document: Guidance to the mattress and related devices General Requirements standard BS EN ISO 20342-1:2022
PD CEN ISO/TR 20342-7:2022 | 31 May 2022
Further guidance on foams used in mattresses can be found in the BHTA publication: What Lies Beneath
PD CEN ISO/TS 20342-10:2022 | 31 Jul 2022 | BSI Knowledge
Further guidance on cleaning and disinfection of mattresses can be found in the BHTA publication: Protect, Rinse and Dry
Further information on Standards is available from the BHTA article: An introduction to understanding standards
Personal issue kits should be issued to individual first aiders and other employees where appropriate to their role, e.g. security personnel, cleaners, maintenance, etc. as a supplementary resource to small, medium and large first aid kits being available in the workplace.
If your business has people working offsite, in vehicles or lone workers in an isolated environment, kits will need to be issued amongst persons that fall within those categories.
This convenient kit can be worn on the person; it contains essential first aid products enable basic first aid to be provided quickly and easily. The personal issue kit is designed to enable effective CPR and deal with common minor injuries, such as breaks and sprains to arms and small bleeding injuries.
It is recommended that one personal issue kit is issued to each first aider and any other employee and required, following a needs assessment.
Contents:
1 x Guidance leaflet
1 x Contents list
1 x Large sterile dressing
1 x Triangular bandage
10 x Sterile adhesive dressings
4 x Alcohol free cleansing wipes
2 x Pairs of nitrile gloves
1 x Resuscitation face shield
1 x Foil blanket
1 x Pair of universal shears
The critical injury pack contains advanced first aid products, designed to stem catastrophic blood loss and treat life threatening injuries. It is recommended that the critical injury pack is provided wherever a substantial risk of injury has been identified and to supplement first aid kits conforming to the British Standard (BS 8599-1:2019).
A critical injury pack should be provided in any workplace where there is risk of critical injury. A critical injury pack should be available to each employee exposed to these risks.
Examples include: work with dangerous machinery or sharp instruments, cutting equipment, power tools, construction, agriculture, forestry, etc.
It is highly recommended that employees responsible for the delivery of first aid in the workplace be trained in the use of the critical injury pack and its contents, specifically the haemostatic dressings and tourniquet.
Critical injury packs can also be stored in large quantities for distribution in an emergency. Following a risk assessment, an employer should consider storing appropriate quantities of critical injury packs to treat injuries to employees or the public, resulting from acts of terrorism or other mass casualty incidents.
Appropriate numbers of the critical injury pack should be stored, in line with the risks assessed. Employers should take into consideration the maximum number of people on site at any one time, each pack is designed to treat one person.
1 x guidance leaflet
1 x contents list
2 x pairs of nitrile disposable gloves
1 x foil blanket
1 x pair of universal shears
2 x large trauma dressings
2 x haemostatic dressings
1 x emergency tourniquet
The personal issue kit is intended to be issued to first aiders and other employees where appropriate to their role (e.g. security personnel, cleaners, maintenance, etc). This kit should be provided in addition to an appropriate number of British Standard compliant first aid kits being available in the workplace.
This convenient kit contains essential first aid products to enable basic first aid to be provided quickly and easily.
It is recommended that one personal issue kit be issued to each first aider and any other employee as required, following a needs assessment.
1 x guidance leaflet
1 x contents list
1 x large sterile dressing
1 x triangular bandage
10 x sterile adhesive dressings
4 x alcohol free cleansing wipes
2 x pairs of nitrile gloves
1 x face shield
1 x foil blanket
1 x pair of universal shears
Click here and search for “First Aid Medical Equipment” for further information on reputable brands, manufacturers, and suppliers.
This article is designed to help users and carers in the public domain to learn more about preventing pressure ulcers when sitting in a chair or wheelchair. It is not intended for clinicians. The article was put together by BHTA industry expert members.
A pressure ulcer is any area of localised damage to the skin and underlying soft tissue. There are a number of risk factors, including age, diagnosis, medication, continence, nutrition, mobility, and weight. There are also other factors not specific to the person, such as the support surface, temperature, and moisture. (1)
Whilst sitting, the skin and soft tissues get squeezed and deformed between the bone and the support surface. Over time this can cause the cells to die and the area of resulting dead tissue is called a pressure ulcer.
TIP: Everyone is potentially at risk of developing a pressure ulcer (2)
When sitting in an upright stable position, we still have localised high-pressure areas:
Therefore, posture and pressure are linked, with both affecting one another.
Early symptoms of a pressure ulcer include:
TIP: With care, pressure ulcers are mostly preventable (7)
Prevention can not only improve a person’s outcomes, but it can also reduce the costs to the NHS and benefit the wider community:
Consult a general practitioner or healthcare professional for information and advice on:
TIP: Chair functions, such as tilt-in-space, can be effective in redistributing pressure
Case study:
This article is designed to help users and carers in the public domain to learn more about good posture when sitting in a chair or wheelchair. It is not intended for clinicians. This article was put together by BHTA industry expert members.
Posture is the way we hold ourselves or body segments in relation to one another and their orientation in space. Body positioning can be intentional or unintentional.
Body segments (1):
Posture has two main purposes:
The body structure is a very complex system. It is naturally unstable but highly flexible, which allows for a wide variety of postures but also makes it very vulnerable to damage.
TIP: Posture is influenced by body shape and size, the supporting surface, and even health or emotional state
When poor seated posture is adopted over prolonged periods of time, a person can experience:
Good posture (2):
TIP: Failure to manage posture can result in many health complications
Postural management is the use of any technique to minimise postural problems and enhance health (3). It must be individualised, targeting all body segments. It must also take into consideration the full 24-hour period.
TIP: Select a chair to suit body shape and size
Contact a healthcare professional for advice on postural management.
Case study:
Road accidents are common in the UK with 181,384 injuries reported in 2016.
It is an employer’s legal responsibility to ensure all employees have access to a first aid kit, appropriate to the level of risk in their workplace, including employees who work away from the office and on the road.
A vehicle first aid kit, designed with associated risks in mind, contains essential equipment to provide early treatment at the roadside.
Ambulances are targeted to reach an emergency in eight minutes, though it can often be longer due to traffic and volume of calls. An untreated casualty with a severe enough injury can bleed out in a much shorter time, without treatment. A trauma dressing can be used by any bystander to potentially save someone’s life.
Kits that meet British Standard 8599-2 are designed for professionals and untrained bystanders. Items carried in the kit are designed to be useful and practical for professional first aiders, but they are also simple and intuitive enough to be used by anyone in an emergency situation.
While there are many vehicle first aid kits on the market, the British Standard 8599-2 compliant first aid kit is the first to be designed by a panel of industry experts who were invited to help the BHTA design the new vehicle first aid kits. The kits have been created to treat the most common roadside injuries.
Examples of products include:
Employers must provide first aid suitable to risks identified in the workplace. Company vehicles should be considered a workplace. It is for employers to decide if the first aid kit carried by their employees is sufficient for the risks employees are exposed to. A British Standard 8599-2 compliant first aid kit is the ideal solution for vehicle first aid.
| Number of passengers | Vehicle examples | Number of first aid kits required |
|---|---|---|
| 1-3 | Mopeds, motorcycles, motor tricycles, and quadricycles | 1 |
| 1-8 | Cars, taxis, and commercial vehicles | 1 |
| 1-16 | Minibuses and small buses | 1 |
| 17+ | Buses and coaches | 2* |
*Multi-level vehicles might require more than two kits
1 x Triangular Bandage
1 x Dressing, Adhesive 7.5cm x 7.5cm
1 x Dressing, Sterile Medium 12cm x 12cm
1 x Dressing, Sterile Medium Trauma 10cm x 18cm
2 x Hydrogel Burn Dressings 10cm x 10cm
1 x Foil Blanket 130cm x 210cm
2 x Nitrile disposable gloves (pair)
1 x Guidance Leaflet
10 x Plasters, Washproof Assorted Sizes
1 x Resuscitation Face Shield
1 x Shears (suitable for cutting clothing, including leather)
10 x Alcohol Free moist cleaning wipes
1 x Contents List
Please contact BHTA on 020 7702 2141 to find your nearest First Aid Supplier to you.
Copies of the document are available to purchase from the BSI here or by telephone on 0345 086 9001.
There are many brands of defibrillator available. While they may look different, all defibrillators are reasonably similar and will deliver a lifesaving shock in an emergency.
Defibrillators are known by several names, including:
Look out for the defibrillator sign in your workplace and public areas.
Semi-automatic defibrillators require the rescuer to press a button to deliver a shock. Fully automatic defibrillators carry out a short countdown and deliver a shock automatically. Both versions have pros and cons, depending upon where the defibrillator is to be used and by whom. Your ambulance service or a BHTA supplier will be able to offer advice to help you make the right choice.
There are many defibrillators available in public places such as train stations, shopping centres, airports, and leisure centres. These defibrillators are often known as PADs and are usually found in yellow or green cabinets if they are outdoors or a white cabinet if they are indoors. Whatever the colour, the cabinet will always have the defibrillator sign on it. Some cabinets need a code to open them; some cabinets are already unlocked. If you need to get into a cabinet that is locked, simply call 999 and they will give you the code. These are provided for the use of everyone in an emergency.
If you need to find your nearest PAD in an emergency, call 999 and the call handler will help you if there is one nearby.
Larger companies are likely to situate a defibrillator in the main reception or close to a first aid room. There are many places defibrillators can be found; remember to look for the sign.
The amount of time between arrest and defibrillation is one of the most important factors during a cardiac arrest.
Using a defibrillator within the first three minutes of collapse can increase the chances of survival by up to 70 percent. http://www.nejm.org/doi/full/10.1056/NEJMoa040566#t=article
Every minute after this reduces chances by approximately 10 percent. It is critically important to act quickly.
Some people mistakenly feel that they may be held responsible if the casualty does not recover. This is not the case; a person using a defibrillator cannot be held liable for trying to rescue a casualty.
http://www.legislation.gov.uk/ukpga/2015/3/contents/enacted
Defibrillators are designed to be used by anyone, with or without training.
A defibrillator will never deliver a shock unless the casualty needs one. Training is advisable but is not compulsory. Training will improve the user’s confidence in an emergency.
Most defibrillators can be accessed easily, without keys or codes. Some community defibrillators are protected by a locked cabinet. In this instance, instructions on how to open the cabinet in an emergency will be clearly shown.
Both visual and audible instructions will be given by the defibrillator. The instructions are simple to follow and clearly given.
All defibrillators are maintenance free.
Click here and search for “First Aid Medical Equipment” for further information on reputable brands, manufacturers, and suppliers.
Augmentative and alternative communication (AAC) services help people to communicate as effectively as possible when speech is impaired.
The term AAC covers a wide range of techniques that support or replace spoken communication. Techniques include gestures, signing, symbols, communication boards and books, as well as powered and computerised devices such as voice output communications aids (VOCAs).
AAC is used to help people express themselves who may have no clear speech. There are many possible causes including cerebral palsy, stroke, head injury, motor neurone disease, or a learning disability.
Since April 2013, NHS England became responsible for commissioning services with the most complex needs. These 15 specialist services are commissioned and funded with a national service specification for AAC. AAC services are organised and funded differently in the different countries in the UK.
This has been described as the AAC “Hub and Spoke” model with the regional “hubs” able to provide specialist services and support to a number of local centres, or “spokes” offering AAC services. Funding for local AAC services (spokes) is within the remit of Clinical Commissioning Groups (CCGs). In Wales, Scotland, and Northern Ireland there are specialist AAC services set up to assess children and adults with the most complex needs. These services are funded by the NHS and/or education.
Local AAC services carry out assessment and provide AAC equipment for individuals who are not yet eligible for specialised services. They also implement equipment provided by the specialised services.
Your local AAC service should support a managed care pathway for children and adults with less complex needs, make appropriate referrals to specialised AAC hubs and other relevant services, and coordinate the support required. You may be referred to a multidisciplinary team that typically would include speech and language therapists, occupational therapists, educational professionals, and experts in assistive technology.
Aided communication involves additional equipment that may be paper-based or electronic, often referred to as ‘low-tech’ or ‘high-tech’.
Low-tech communication systems do not need a battery to function. Examples are pen and paper to write a message or draw, alphabet and word boards, communication charts or books with pictures, photographs, and symbols or objects used to represent activities or items.
High-tech communication systems need power from a battery or mains. Most of these systems speak and or produce text. They range from simple buttons or pages that speak when touched, to very sophisticated systems based on familiar equipment such as mobile devices, tablets, and laptops. Some high-tech communications systems are based on equipment specially designed to support communication.
To find the nearest centre to you, please visit the Communications Matters here.
Assessment services will be able to advise about funding. A thorough assessment is necessary before requesting funding from health or education services. NHS England has a system for the provision of communication aids. Scotland, Wales, and Northern Ireland have their own systems.
Top ten tips for making communication successful:
Choose a quiet place so you can both concentrate on the conversation.
However, remember not all children and youngpeople will be happy, or able, to look you in theeye. Those with autism may find this particularlydifficult, and young people using a communicationaid will have to look at what they are doing.
This will give the other person the opportunity to show you the best way to communicate with each other.
Ask them to show you how they use their AAC system to help you understand what, if anything, you need to do to make communication successful.
This may not always be the obvious nod and shake of the head.
This sounds obvious. For some people it may take them longer than you may usually wait for an answer.
Sometimes it can be tempting to finish off a person’s sentence for them, and some welcome this as a way of speeding up communication. However, others may find this annoying, so always ask if the other person is happy for you to do this.
This will give the other person opportunity to explain points that have been understood or ask for support.
It’s important to give time to the conversation.
When finishing a conversation, make sure that you both agree you have said all what you wanted to and check you have both understood everything that was communicated.
Resources: http://www.communicationmatters.org.uk/resources
The BHTA has worked with the Don’t Call Me Mum campaign initiative to produce this article. We want to help professionals and companies working with carers and families of adults and children with additional needs to demonstrate their respect of parents as partners.
When you enter a family’s house, it is also their home, their place of comfort, and a safe space. Whilst keeping this in mind, professionals should understand the potential anxieties and fears families may have around outsiders entering their home and the decisions that may be made. Working with parents/carers and involving them at every stage of a meeting/assessment will help gain their respect and trust.
Companies, professionals, and parents are all the experts in their own right. Bringing together everyone’s skills, knowledge and resources creates the best outcome because when parents are partners; everyone, especially the person with the disability, wins.
Every family has a story. Every interaction is part of an ongoing journey littered with complications, emotions and challenges.
Every person has a different set of priorities and expectations. When each party openly communicates their agenda and priorities, progress can be made.
We have established some top tips to help when working with families.
The BHTA is one of the UK’s oldest and largest healthcare trades association. To find out more about the BHTA and see other useful guidance articles, click here.
To become a supporter of ‘Don’t Call Me Mum’ and show that your company, department, or school acknowledges the essential contribution parents make, order your supporters pack and contact us to add our logo to your website. Email us: info@dontcallmemum.com or visit the Don’t Call Me Mum website.
With thanks to Born at the Right Time bringing a family’s perspective to professional practice and pioneer of the Don’t Call Me Mum initiative.
The BHTA has produced this guidance to ensure families and carers understand what an assessment is and what outcomes should be achieved.
Assessments can be face to face or virtual, depending on the type of equipment being assessed for. Regardless of whether the assessment is online or in person, there are certain things you can do to make sure you and your family get the most out of the process.
A health professional will carry out the assessment. They must be qualified, trained, and experienced in identifying needs and offering suitable solutions for disabled children.
If your child has an education, health and care plan (EHCP) in place, it is important that any needs identified in the assessment are included and specified in the plan. There are legal obligations for the EHCP to cover all needs identified in relation to education, health, and care, including equipment provision (as stated in the Children & Young People’s Act 2014).
Questions to ask before the assessment:
It’s important to know where the assessment will take place. If your child’s needs are such that you would prefer the assessment to take place at home, you can request this. However, some assessments may need to take place in a clinic for practical reasons, in order to achieve the best outcome for your child. An example of this might be when the equipment being considered needs to be tried out.
If your assessment is virtual, it is important to know how the call will be accessed and which platform it will be on (Zoom or Teams, for example). Any reputable organisation will be happy to take you through a trial call so any technical difficulties can be ironed out.
If the assessment is for larger pieces of equipment, it can be helpful to see the room where it will be used. It can also be useful to have a tape measure to hand to give dimensions, if needed. There may be further questions which will be asked on the day, and sometimes a physical assessment may be necessary following a virtual one.
If the assessment is virtual, it is important to check your internet connection to make sure it is working correctly.
Prepare your child for the assessment by explaining what will happen.
Follow the “Nothing about me, without me” approach.
It’s important that the assessment does not feel rushed. If you are concerned that your child is uncomfortable during the assessment and that it won’t be possible to get an accurate picture of their needs, ask to reschedule.
If you have concerns about the equipment being discussed, you can raise them during the assessment.
If the therapist believes a specific piece of equipment is needed, they need to ensure that either you or the family understand why and how it will contribute to your child’s wellbeing.
Before the assessment is completed, there should be time to ask questions. You may want to know:
The Health and Safety (First Aid) regulations 1981 states: “An employer shall provide, or ensure that there are provided, such equipment and facilities as are adequate and appropriate in the circumstances for enabling first-aid to be rendered to his employees if they are injured or become ill at work.”
The Health and Safety Executive (HSE) provides a code of practice and guidance to help you meet your obligations under the law. Whilst this is guidance and not law, following this will ensure that you meet your legal obligations regarding first aid in the workplace and will demonstrate, if ever questioned, that your first aid provision has been considered against a risk assessment and is appropriate.
This code of practice and guidance covers all manner of topics relating to first aid, like first aid training, where it gives some practical guidance about how many trained first aiders you need in a workplace. With the contents of first aid kits, it only gives a list of the type of products that you might include in a first aid kit, and points to the BSI for further guidance.
The HSE guidance focuses on the importance of a needs assessment. All employers should conduct a needs/risk assessment in order to decide on which first aid kits are needed and where they should be sited. The British Standard BS 8599-1 provides some very useful guidance to help employers match their needs with BS8599-1 compliant kits.
A range of workplace first aid kits are detailed in British Standard BS 8599-1. These kits have been professionally designed to help you fully comply with the HSE code of practice and guidance, and hence fully meet your obligations under the law. The standard is regularly reviewed to keep it up to date.
The BS 8599 range comprises:
Since the HSE guidance is not binding, some workplace first aid kits are available that fall well short of the British Standard. By using these kits, an employer is not breaking the law. If, however, there is an incident, and an employee suffers harm that could have been prevented should a British Standard kit have been available, it might be difficult for employers to legally defend themselves.
Some kits are called HSE first aid kits; there is no such standard. Some kits quote British Healthcare Trades Association (BHTA) standard; this standard was withdrawn in 2012 and replaced with the BSi standard.
Choosing the right first aid kit is now even easier. Decide if your work environment is low hazard or high hazard by reading the table (below). Then how many employees there are in your workplace and finally which of the three sizes of kit you will need, e.g. small, medium or large. It’s that simple!
e.g. shops, offices, libraries etc.
| Number of employees | Size of first aid kits |
|---|---|
| Fewer than 25 | Small |
| 25-100 | Medium |
| More than 100 | Large (1 per 100 employees) |
e.g. light engineering and assembly work, food processing, warehousing, extensive work with dangerous machinery or sharp instruments, construction, chemical manufacture etc.
| Number of employees | Size of first aid kits |
|---|---|
| Fewer than 5 | Small |
| 5-25 | Medium |
| More than 25 | Large (1 per 25 employees) |
| Contents | S | M | L | Off-site |
|---|---|---|---|---|
| Sterile adhesive dressings | 40 | 60 | 100 | 10 |
| Nitrile disposable gloves (pairs) | 6 | 9 | 12 | 2 |
| Burn dressing Min 100cm2 | 1 | 2 | 2 | 0 |
| Resuscitation face shield | 1 | 1 | 2 | 1 |
| Guidance leaflet | 1 | 1 | 1 | 1 |
| Contents list | 1 | 1 | 1 | 1 |
| Shears (suitable for cutting clothing, including leather) | 1 | 1 | 1 | 1 |
| Sterile finger dressing | 2 | 3 | 4 | 0 |
| Sterile eyepad dressing | 2 | 3 | 4 | 0 |
| Sterile medium dressing | 2 | 4 | 6 | 0 |
| Sterile large dressing | 2 | 3 | 4 | 1 |
| Conforming bandage (min 7.5cm width and 4m stretch length) | 1 | 2 | 2 | 0 |
| Triangular bandage | 2 | 3 | 4 | 1 |
| Foil blanket (130cm x 210cm) | 1 | 2 | 3 | 1 |
| Adhesive tape rolls (Individually wrapped, min 2.5cm width, 5m length) | 1 | 2 | 3 | 0 |
| Alcohol-free moist cleansing wipes | 20 | 30 | 40 | 4 |
Please contact BHTA on 020 7702 2141 to find your nearest first aid supplier.
Copies of the document are available to purchase from the BSI web shop or by telephone on 0345 086 9001.
Orthoses are medical devices that are applied externally to the body for therapeutic effect. Orthoses are designed to alter the biomechanics of the human body. They may be used to redistribute pressures acting on the body, offload or immobilise painful joints, improve stability, optimise body alignment, and improve walking patterns.
Examples of orthoses include footwear, inlays, simple insoles, bespoke devices, braces, splints, supports, and callipers. Orthoses can be prescribed for all parts of the body, from the head to the toes.
There are many types of patients who may benefit from an orthotic device, these include people with:
If you would like to know if an orthosis can help you, it is always best to speak with your GP or healthcare professional.
The goals of treatment will be different for each person who uses an orthotic device.
For some, an orthosis will enable them to carry out their daily activities with less pain, helping them to maximise their lifestyle. Others will use an orthosis to help improve their mobility and undertake tasks that would otherwise be a challenge or unachievable.
Surgeries carry risks, and not every person may be a candidate for an operation. Orthoses are routinely used as an alternative to surgery or as a tool to help a person until they are fit and well for an operation. Post-surgical rehabilitation and recuperation timescales can be lengthy and therefore using an orthosis can help a person postpone or delay surgery until a convenient period in their life.
Orthoses are often used in wound prevention, particularly for those identified at high risk of tissue breakdown. Use of an orthosis in this manner may allow a person to maintain their current lifestyle with confidence, given the knowledge that their body is being protected.
To find out which type of device will work best, a thorough biomechanical assessment is advised. This can be provided by an orthotist who is a healthcare professional qualified to assess, prescribe, and supply orthoses.
For many, a simple ‘off the shelf’ or ‘over the counter’ device may be sufficient to help them manage their condition. For those with more serious, complex, or critical health conditions, provision of a tailored or fully bespoke orthosis may be in their best interests. This will be decided between you and the orthotist.
Orthotists are allied health professionals (AHPs) who assess for, prescribe, and fit orthoses. They are HCPC registered and regulated. The status of an orthotist can be checked via the HCPC website.
Orthotists complete in-depth university teaching to ensure expert knowledge of the body: its anatomy, function, and pathology. Training develops skills in biomechanics, material science, engineering design, and workshop craft.
Orthotists are uniquely placed to offer the best services to those who may require an orthosis. Whilst there are many orthotic specific services, orthotists are increasingly integrating with their healthcare colleagues to provide joined up services.
Orthotists can work in both the NHS and independent service sectors.
An orthotic consultation should start with a discussion about your medical history and current health conditions that you would like the orthotist to help manage. Your aims and goals of treatment should always be considered.
With your consent, a physical assessment will be undertaken, and the orthotist will explain their findings. For some health conditions, the orthotist may advise that further tests or imaging are required to learn more about your alignment. If your health condition affects your walking, it is normal for the orthotists to observe your gait (walking pattern) to examine how this can be made more efficient or more comfortable.
It is always useful to bring with you any orthoses that have been prescribed in the past. This will help the orthotist to see what has or hasn’t been successful.
After assessment, the orthotist will formulate an orthotic prescription. This is a design blueprint that details the specifications for the device that you will require. At all times, the orthotist will consult with you to consider your preference, if there are different styles available or aesthetic options.
Once a prescription is agreed, the orthotist will take measurements required to allow manufacture of your orthosis. Sometimes a foam impression box, 3D scans, moulds, or plaster casts of the body may be required to ensure a bespoke fitting orthosis can be made.
The orthotist will arrange a treatment cycle including fitting and tailoring sessions, supply appointments, and a review format. When you are supplied your device, you should be given full instructions as to how to use and care for the orthosis as well as on how to adapt to the correction level.
Referral routes to NHS services will vary on a local level. Typically, this will be via your GP, consultant, or healthcare therapist. In some regions, you may be able to self-refer to your orthotics service.
Many NHS services are contracted out to independent orthotic service providers, many of whom are BHTA members.
You can also arrange to see an orthotist privately. Private treatment may be an option for a person who requires additional devices to that provided by their local NHS service, expedited supply of an orthosis, a specialist orthosis for sporting or vocational use, and secondary consulting opinions.
All expected consultation fees and anticipated product fees should be outlined to you at the time that you book a private consultation.
When buying orthoses privately for your own personal use you may not have to pay VAT. Where this is the case, your provider will ask you to complete a VAT relief claim form and will then deduct the VAT.
Ensuring that the manufacturer of your orthosis and/or the provider of your orthotic service are BHTA members is important for several reasons. BHTA members subscribe to a Code of Practice that is designed to protect the consumer and encourage higher standards than those simply outlined by law. Should you be in the unfortunate position that you require to make a complaint, BHTA members are signed up to an impartial complaints and mediation service.
A list of BHTA members is available on the BHTA website here. Search for orthotics to find manufacturers and suppliers.
The British Association of Prosthetists and Orthotists (BAPO)
www.bapo.com
The Health and Care Professions Council (HCPC)
www.hcpc-uk.org
The International Society of Prosthetists and Orthotists (ISPO)
www.ispoint.org
NHS Choices
www.nhs.uk
This article was developed in partnership with QEF Tryb4uFly.
Flying is an essential and desirable form of transport for millions of UK citizens each year, whether for business, pleasure, family, or health reasons.
Speak to your GP or consultant in the first instance. Airlines want to ensure that your condition is stable and may ask you a set of questions when you book.
You can view specific flying advice related to your disability, for example at the Stroke Association or the British Heart Foundation. The UK Civil Aviation Authority (UK CAA) features advice for disabled passengers before planning their journey.
That is up to you! Bear in mind that each country’s disability discrimination laws vary, and it pays to research your own essential requirements before you fly. If you have not flown before or want further guidance, speak to specialist travel agents who are experienced in supporting disabled travellers, for example, Enable Holidays.
Flying to and from the UK, you are allowed to take an additional two pieces of mobility equipment free of charge. This can include a wheelchair, a special seating system, or specialised buggy. Always check with your airline when you book. Some travellers like to hire equipment instead at their destination. Consider Mobility Equipment Hire Direct.
Yes, you can take your manual or powered wheelchair or scooter. If battery powered, it is subject to the dangerous goods requirements. The airline you choose to fly with will ask about the make and model of your wheelchair, its weight, and dimensions. If it is a powered chair or scooter, the airline will also need to ensure the batteries are safe in transit.
You can look at the BHTA website for information about your wheelchair and how it will need to be immobilised when stored in the aircraft hold. Consider the use of an Airsafe Plug. Take a copy of your wheelchair manual, and notify your wheelchair services if it’s not privately owned.
If taking over 100ml of medication, you will need a doctor’s letter. There is no limit to the amount you can take with you in the cabin. It’s advisable to take a doctor’s letter declaring medical implants, and if you are travelling to Middle Eastern countries check the legality of any drugs you plan to bring with you.
The UK CAA has an Aviation Health Unit for medical questions related to being in the cabin. Take essential prescriptions with you should you be delayed at your destination.
Always pre-disclose medical conditions. Consider the cover you will need not just for yourself but for your travelling companions, any staff accompanying you, and essential equipment.
Bear in mind that cover for some countries will cost significantly more than others, and, if airlines damage essential equipment, there is an international limit to the amount they may reimburse you, regardless of the value of your equipment. Speak to specialist disability/travel insurers like Fish Insurance or Free Spirit.
Whether you book directly with the airline on your phone, via a travel agent, or online, it is your responsibility to communicate your requirements at least 48 hours in advance of your journey – or preferably when you book. ‘Pre-notifying’ helps the airline and airport to plan the support you require for both outbound and inbound flights. Check your request for assistance has been received with your airline.
According to European Law 1107/2006, you have the right to assistance from the time that you arrive at the airport. This can include getting from a hotel within the airport boundary to the terminal entrance. Take the time to look at the maps and videos of the airports you are using before your day of travel. These will show you where the special assistance receptions are and identify them.
Take the time to see the arrangements your airports have in place if you are parking. Most will allow you to park at the short- and long-stay car park for the normal fee. By prior arrangement, you may take a copy of your Blue Badge on your journey. Take a look at the AA (www.theaa.com) for advice on how you can use your Blue Badge abroad.
However, you arrive at your airport, you can request assistance from call points to help you make your way to the special assistance reception. Here, your assistance needs will be checked for your onward journey through the airport and boarding the aircraft. This can include chaperoning, support with carrying luggage, and boarding.
If you have luggage, you will need to visit the check-in desk, so your bags can be stored in the hold. If not, it’s likely you will have already checked in online and have either a printed or on-screen boarding pass. Remember that you can stay in your wheelchair all the way through to the aircraft door and that it will be tagged, in the same way that luggage is. You may be asked about your wheelchair dimensions and weight again.
Visit the airport before you travel. Take a look at the resources airports provide the autistic traveller, including videos and online checklists.
Airport lounges can be a good investment for a place that is quieter, and make a plan should your flight be delayed. Request special assistance before you travel.
Consider a journey by coach, train, or underground as a means of assessing you or your travelling partner’s suitability if you have never flown. Bring items that soothe, relax, or distract for the journey, and have a plan if your flight is delayed.
It is likely you will be fast tracked – you may be invited to join a queue for families. You can remain in your wheelchair if you use one; the team will take a small swab and wipe it on an item of your clothing to check that you are not carrying any unauthorised substances.
Before any ‘pat down’, inform the staff member of any particular requirements and if you wish this to be done away from the queue. Be prepared that security checks may be somewhat different when you return from your destination airport.
Once through security you will be in the departure lounge. Most airports have a prominent special assistance area where you can wait for information or go shopping. Some provide a pager to notify you when you need to return. It is from here that you will board an airport buggy to take you to your gate.
Check the facilities at the airports you are flying from, and to. While most should have accessible toilets, check with Changing Places to find out the availability of full changing facilities.
Getting to your aircraft can involve surprisingly long distances. You may want to save your energy for another part of the journey, so make the most of the assistance airports provide. Maps are available online of the distances involved in travelling through airports to help you plan.
There are different ways to board the aircraft: by using steps, an Ambulift, an Airbridge (or jetty), or an Aviramp (a portable slope). A stairclimber is also available for smaller aircraft and airports. You may need to use a bus to get to the aircraft stand.
It’s important to know that airlines use different means of boarding depending on the aircraft type, what is available at the airport, and their arrangement with the airport. Ask questions about the arrangement the airline has in place at your airports when you book your flight.
Once you reach the outside of the aircraft, you will be welcomed on board by the aircraft cabin crew. Bear in mind that in the UK and Europe, if you require assistance, it will be the airport team that continue to assist until you get into your designated seat. If you use a wheelchair, you will now need to move into a transfer chair. The airport team will support you with your manual handling requirements. Communicate your requirements to the team before you are lifted.
A more dignified transfer can be achieved with the use of a Promove sling. Some UK and international airports also provide the mobile Eagle Hoist. Check for its availability at Haycomp.
Generally, airlines want to seat you so that you have a short distance to travel from the front or rear of the aircraft. If you are travelling alone, you will be asked to sit in a window seat in an economy seat configuration. There can be further restrictions on seating location due to cabin safety rules. Use SeatGuru to look at your seat choice ahead of your flight, and always check with your airline.
The amount of room for your legs is measured as ‘seat pitch’ and not leg room. If you need additional support, consider options including the Stabilo Cushion, Crelling Harness and MERU TravelChair for children. These are available to try ahead of your flight at QEF’s Tryb4uFly service. All aircraft seats will be required to be in an upright position for take-off and landing.
Cabin crew can assist you getting to the door of the toilet using a narrow aisle chair. Toilets are small. If you have particular concerns, we recommend speaking to your continence nurse/adviser. Some new aircraft have two adjacent toilets with a folding wall that provides double space, including the Boeing 787 Dreamliner, depending on configuration.
If you need oxygen for medical use, you can bring small gas oxygen or air cylinders with you, but you will need to seek the airlines approval first. International safety rules allow small gaseous oxygen or air cylinders required for medical use (no more than 5kg gross mass per cylinder), but the airline’s approval is required.
Devices containing liquid oxygen are prohibited. There is no blanket airline prohibition on the passenger using their own oxygen. Passengers should check with their airline.
Discuss your requirements with your airline when you book. If there are any specific liquids or drinks that you need to bring and they exceed 100ml, you will require a letter from your doctor.
If you use a wheelchair, remind cabin crew before you begin your descent that you will be expecting your wheelchair to be available immediately when you exit the aircraft.
If you are a wheelchair user or require assistance, anticipate exiting the aircraft last. While this can result in a delay to your journey, often you will make up this time as you are escorted through the airport. Remember that your destination airport is likely to have different facilities and access options. Investigate these before your flight.
Always make a contingency plan if your flight is delayed, for whatever reason. Contact your airline or airport in the first instance if your journey does not go as planned. If they have not dealt with your complaint satisfactorily, contact the UK CAA online or call 0207 4536888.
Powered mobility products are divided into Class II, Class III, and ‘not in a class’ vehicles. Class II are limited to up to 4mph and in general are designed for pavement use. Class III mobility products have a maximum speed of up to 8mph for road use but have a switch to reduce the maximum speed to 4mph so they can also be used on a pavement. Class III vehicles need to be registered with the Driver and Vehicle Licensing Agency (DVLA).
Where pavements do not exist, you may have to use the road until you can return to a pavement at the first opportunity.
Both Class II and Class III vehicles can be used on cycle tracks. However, Class II and Class III mobility vehicles cannot be used on cycle lanes.
‘Not in a class mobility vehicles’ are those that can go more than 8mph, are wider than 0.85 metres, and weigh more than 150kg (or 200kg if you need any equipment attached to it – for example, medical equipment). Not in a class vehicles can only be used on the road.
Not in a class vehicle owners will also need to get a valid driving licence to drive one and register their vehicle with the DVLA. You may also need to insure your vehicle.
If you are unsure of what class your mobility vehicle falls under, the retailer or manufacturer should usually be able to tell you. Otherwise, you can check based on its speed, width, and weight.
Driven safely, mobility products can give people freedom and independence. In the wrong hands, they can do considerable damage to property and other pedestrians.
The categories of road users in the Highway Code are pedestrians, cyclists, motor cyclists, and motorists. As a wheelchair/scooter user, you don’t really fit any of these categories. You may however partly fit one of them.
Some wheelchairs/scooters can only be driven safely on the road. This does not always make it safe to do so. To drive safely on the road, it is advisable to have a Class III vehicle capable of doing 6/8 miles an hour, equipped with headlights, rear lights, flashing indicators, and a horn. Even with all this, you may not use dual carriageways unless you also have an additional flashing beacon light. You are not permitted to use bus lanes or cycle tracks.
Under no circumstances is it permissible for scooters or wheelchairs to be driven on motorways.
Make sure you are able and fit to use it safely. It is usually possible to get advice through your local social services or occupational health service and your doctor.
You need to be able to:
It is important to talk through your requirements with a BHTA specialist or talk to your therapist or healthcare professional if you need advice. This applies even if you have driven a car previously, as it is very different from driving a scooter/wheelchair. If you would like advice from a BHTA specialist, click here and type in “mobility” in the Find a Member section.
At present, there is no overall legal obligation about insurance, though some finance companies insist on it. Nevertheless, it is a very good idea to make sure you are covered for fire and theft, accidental and malicious damage, and third-party damages – just in case. The BHTA has members that can provide insurance for your mobility vehicles.
Make sure your vehicle is the right one for you. Get advice when choosing and watch for things like seat and handle positions and height. It is important you are comfortable and in full control of your vehicle.
The reasons for choosing three- or four-wheeled vehicles are varied and depend on many factors such as your weight, size and height, weight of chair for lifting, and quality of your roads. You need to be extremely careful when ascending and descending kerbs and when turning, as if this is not done carefully and properly the scooter will tip.
The manufacturer’s literature and owner’s manual will tell you the range of your vehicle, but remember this is a guide only. Generally, they tell you the range if driven on the level on a smooth surface and when the batteries are new. Few people would want to drive round a smooth car park for 20-25 miles!
Rough surfaces, hills, gradients, cold weather, kerbs, and carrying a load of shopping will all reduce the distance you can do without charging your batteries. Recharge your batteries according to the manufacturer’s instructions.
Do not be too ambitious where distance is concerned. Build up your experience and range gradually.
Many mobility insurance packages include a “get you home” service within their policies, so it is worth discussing with your local BHTA specialist for advice.
Some service providers will provide a special low rate for occasional users who need the phone for possible emergencies.
On the footpath, the limit is 4mph (6.4kph), whatever the capacity of your vehicle. On the road, it is 8mph (12.6kph). If driving a Class III vehicle on the pavement, it must be switched to 4mph mode.
Do not overload your mobility product. It may make the vehicle unstable and reduce its range. Place heavy loads inboard in the middle. Not behind the back wheel, which can lighten the steering or cause the front end to lift off the road on a bump, and not at the front, which might make steering heavy.
Never try to drive, or even sit on, your vehicle while it is in “free wheel”. The electronic brake will be out of action, and the vehicle could run away with you.
Get your vehicle serviced regularly according to the manufacturer’s advice.
Keep tyres at the pressure recommended by the manufacturer. They will last longer and be safer. Replace them when they become worn.
Check bulbs regularly and replace if not working properly. Use your lights frequently, at dusk onwards, and on a dull or rainy day.
These are normally provided with all new mobility products and can give you good advice on how to use and maintain your vehicle. If buying second-hand, it is always worth trying to obtain a copy from the manufacturer for advice.
Just because you are on a footpath or pedestrian precinct does not make you a pedestrian. If you are on a motorised vehicle, you are no longer a pedestrian.
Remember, pedestrians always have right of way. Many people on foot will be kind and helpful to drivers of a wheelchair/scooter but not everyone!
In a crowded precinct or market area, or footpath, it is your responsibility to ensure you do not run into anyone or do any harm with your vehicle. While many people will make way for you, you cannot expect everyone to do so. Some will appear to not even realise you are there. They will climb round and even over your vehicle rather than allow you room to move. Make sure you have your vehicle set to 4mph if it is a Class III (6/8 mph) product.
Do not yield to the temptation to ram them!
Always approach at right angles, with your front wheels straight on the kerb. In some powerchairs, it is necessary to descend high kerbs backwards.
Do not try to climb or descend kerbs higher than the manufacturer recommends. Move carefully to avoid traumatic bumps to yourself or your vehicle.
You may need to ask people to open doors for you. Most people are willing to help, if asked politely. Don’t struggle to do the impossible or even the very difficult things when there are people around who would help if asked.
This is where you have the advantage over car users! Not many supermarkets would welcome a car driving round their store. But bigger shops and even some quite small ones are accessible to wheelchairs and scooters.
Once inside the store, it is your responsibility to drive safely and not damage the fittings, the stock, or hurt other shoppers or store workers. You may need to ask for help. Again, in most cases, people are willing if asked properly. Don’t risk pulling down a whole display to reach the top shelf. Ask for help.
It is a good idea to set the speed control to a lower level to avoid any accident. Be especially careful if you need to reverse; check that your way is clear of shop fittings and people. Three-wheeled scooters with their manoeuvrability and lightness of steering are more suited to shopping.
Remember you are not driving a car but a very small and slow vehicle, which is therefore more vulnerable. If it is possible, use the footpath. It is wise to avoid using roads, particularly busy ones.
Remember, although this is legal for all vehicles, it is not always safe or sensible to do so. You are responsible for your own safety and that of other road users. The normal rules of the road apply but modified.
You must observe the law about:
But always remember your vehicle is not a car and is small and vulnerable.
If you need to turn right across traffic, try to get on to the footpath before the turn, and then use a safe pedestrian crossing or traffic light control crossing. Only try to turn right if you are completely sure it is safe to do so. Do not rely on your mirror. It may give a false impression of distance. Always give clear indication of intention to turn left or right.
Remember – The car you can see when you look behind may appear a long way away, but it is almost certainly moving faster than you are, often deceptively so. It could well be upon you before you complete your manoeuvre. And it may not be able to stop in time.
Take great care you are not moving into the path of a faster moving vehicle coming behind you or towards you. Always signal your intention to pull out.
In the event of a difficult or dangerous situation, use your hazard lights, but do not drive with them on unnecessarily.
Be visible to other pedestrians and road users. When out and about on your mobility vehicle, you can make your presence increase by wearing high visibility jackets or some other reflective wear. It is better to be seen and be safe.
Also read our article on ‘Buying a mobility vehicle’ before purchasing a mobility product.
If you are travelling away from home in the UK and experience a fault or breakdown with your NHS-provided wheelchair, the National Wheelchair Managers Forum has a helpful leaflet called ‘Right to travel UK’ with important information about the support available to wheelchair users.
Generally, for a wheelchair to remain stable, it must be upright on its wheels with the combined centre of mass of the wheelchair and user being within the wheelbase of the wheelchair. These guidelines should only be used in conjunction with the manufacturer’s own manuals and instructions for safe use.
Ramps and slopes can present a high risk to users if they try to climb, descend, or travel across slopes that are steeper than the safe working limit of the wheelchair. Appropriate gradients and surfaces should not cause problems if they are within the capability of the wheelchair. Wheelchairs should only be used on ramps or slopes that are less than the maximum safe slope specified by the manufacturer.
Note: it is important to talk to your local BHTA retailer or supplier. They will give you good advice regarding capability and suitability of each wheelchair.
Wherever possible, wheelchairs should be tested on any slopes that will be used regularly.
When travelling up, down, or across a slope, contact with relatively small obstacles can cause instability leading to tipping or sliding. Hitting obstacles can also cause the seated occupant to slide forwards or fall forwards out of the wheelchair. Use on soft ground can lead to similar problems, as small or narrow wheels tend to sink into the ground. Negotiating kerbs or steps should be undertaken following the manufacturers’ instructions, but always try to use dropped kerbs and ramps where possible.
The addition of some seat cushions can raise the centre of gravity of the wheelchair and reduce the stability of the wheelchair in all directions. The addition of a backrest cushion will move the centre of gravity forward, improving rearward stability but decreasing forward stability.
Seating units fitted into wheelchairs, tilting seating units, or reclining backrests can have similar effects on stability to the addition of cushions, by moving the user upwards and possibly forwards or rearwards within the wheelchair compared to the original seating position. This will affect stability in all directions.
The attachment of accessories or other items such as shopping bags, ventilators, or oxygen cylinders hung or positioned on the rear of the wheelchair will move the combined centre of gravity of the user and wheelchair rearward. This may not cause problems on level ground, but it can make the wheelchair unstable when climbing a slope or ramp. Never carry passengers.
The stability forwards, rearwards, and sideways can be reduced by the user moving their upper body or by leaning out to operate switches or pick something up. However, rearward stability can be improved when climbing slopes if the user can lean forward.
In some cases, the wheelchair will slide down a slope with its brakes applied or tip if it is nearing its limit of stability. Users and carers should be fully aware of the correct method of operation of all the brakes on their wheelchair, and that the effectiveness of brakes can be reduced when the wheelchair approaches its stability limits. Keep tyres inflated to the manufacturer’s recommended pressures.
Anti-tip devices can be added to the front or rear of some wheelchairs to give physical restriction to the amount of tipping that can occur. It is essential that any anti-tip device will have sufficient strength to function correctly when the wheelchair is carrying its maximum user mass on the steepest intended slope.
To improve rearward stability, some wheelchairs have the option of moving the rear axle mount backwards. This could be part of an adjustable mounting or a fixed position further rearward than standard. Rear axle mounts can also be moved forward to improve the manoeuvrability and allow easier tipping to climb kerbs, but it is critical to strike the appropriate compromise between instability and ease of propulsion.
The majority of powered wheelchairs now have the ability to programme the response of the control unit. Users should be aware that any sudden movement of the input device on a wheelchair programmed for fast acceleration can cause instability, particularly on slopes or uneven ground. If this is a problem for a user, then the control unit should be reprogrammed to lower acceleration settings.
The position of the axles is critical to the safe operation of the wheelchair, and any sudden or violent movement can cause the wheelchair to become unstable when climbing, descending, or traversing slopes.
Care should be taken in wet or icy weather, particularly on sloping pavements or vehicle run-ups, as wheelchairs tend to slide to the lowest point.
Lack of maintenance or poor maintenance can lead to the wear or failure of components that may cause the wheelchair or the user to change position unexpectedly. This could lead to the user falling from the wheelchair or tipping over with the wheelchair. Manufacturer maintenance instructions should be adhered to. Always use a qualified technician to service or repair the wheelchair. See also this BHTA article about getting more from your battery.
If the wheelchair is approved by the manufacturer for transportation by a seated person, make sure that you use the wheelchair tie-down and occupant restraint system approved by the manufacturer. If you are using large public buses or trains, use the dedicated wheelchair space and any restraint systems provided.
There is a range of guidance articles on our website. You will also be able to find your nearest BHTA retailer for advice and assistance. Visit the Find a Member section here.
As a wheelchair user, you will find that more and more public transport is becoming accessible to you. New regulations mean that in future, trains, buses, and taxis will all have to be designed so that most wheelchair users can travel in them.
Here are some basic facts that you might find it helpful to know, particularly if you do not use public transport but would like to do so.
The majority of wheelchair users will be able to use public transport. But you may find that you can’t if:
You must ensure that your wheelchair is in a safe condition to travel. This means, for example, making sure that it is correctly maintained, that the tyres are properly inflated, and that you have not overloaded the back of the chair with bags (this can cause the chair to tip over backwards on a ramp). If you have a powered chair, you must also ensure that the battery is secure.
If your chair has adjustable kerb climbers, you should check that they are set so that they do not catch on the ramp.
The transport operator has the right to refuse to let you travel if they believe that your wheelchair is not in a safe condition.
There will continue to be a need for door-to-door transport services for those who cannot be public transport users.
There are different kinds of boarding aids to help you use public transport.
On mainline trains (intercity, suburban, and cross-country) and in buses there is a space designed for you to travel in safety and comfort. You must always use this space.
The reason the wheelchair doesn’t need to be secured in the conventional way on these types of vehicles is because of their design and movement characteristics. They are more stable than smaller or higher floor vehicles, so there is less sway while the vehicle is travelling. But you should always apply your brakes when the vehicle is moving.
Most trams or light rapid transit systems also have a dedicated space for wheelchair users. On systems that don’t, it is important not to sit where you are blocking gangways or doors, particularly if the vehicle is crowded.
In a taxi or a high-floor bus or coach, you may find the wheelchair position is either forward or rear facing, but, in either case, the wheelchair must be secured to the floor of the vehicle with a restraint system. There will also be a passenger seat belt or harness. This is to ensure that you are safe and that your wheelchair cannot move around inside the vehicle and injure you or other passengers. Again, your brakes should always be applied. You should never travel facing sideways. It is not safe.
If you have never used public transport before, don’t be put off. Many transport companies now offer disabled people the chance to see how the system works – perhaps by a visit to the bus or railway station – before you travel for the first time.
Don’t pick a busy rush hour for your first journey if you are uncertain how you will manage. Travelling in the middle of the day will give you more space and time to build up confidence.
Public transport companies have invested time and money in making their vehicles and services accessible. They want you as their customers!
These are some of the organisations who provide useful information and advice.
Telephone: 0161 351 1475
www.ctauk.org
Telephone: 0300 999 0004
www.livingmadeeasy.org.uk
Hand hygiene is widely acknowledged to be the single most important activity that reduces the spread of infection. Hand hygiene should be performed immediately before and after every episode of hands being contaminated.
There are four aspects to quality hand hygiene:
There needs to be more education and awareness regarding the appropriate use of soap and water and alcohol-based hand sanitisers. There must be a clear understanding of how and when these different applications should be used.
Hand cleansing using the correct technique, with a mild soap and water and then dried with a disposable absorbent paper towel, is the best policy to help prevent the spread of germs and for cleaning visible dirt from hands as well as many bacteria and viruses.
Hand sanitising with an alcohol-based sanitiser with a minimum of 60 percent alcohol as an active ingredient can be a very good substitute provided hands are not actually dirty, for use without water, to kill germs and provide a high level of hand hygiene and skin disinfection on visibly clean hands.
The World Health Organization (WHO) claims that: “Hand sanitising may be of benefit when used after hand cleansing but it should not be regarded as a substitute for soap and water since sanitisers will not remove any contamination from the hands. It should therefore be remembered that alcohol sanitisers are not suitable for use on hands that are dirty, contaminated and soiled, e.g. faeces and secretions, or during outbreaks of diarrhoeal illness, e.g. Norovirus and C diff. In these instances, washing hands with mild soap and water is necessary.”
There is a common misconception that anti-bacterial soaps provide a better level of protection than ordinary soaps and therefore should be used widely. In reality, infection control nurses advocate that the use of a mild soap (preferably dermatologically tested) that is kind to the hands and therefore encourages regular hand washing, coupled with good hand washing technique, is much more important than the use of an antibacterial soap.
In a study which split a thousand households into two groups, one group received anti-bacterial cleaning soaps and the other plain soaps. Neither the researchers nor the participants knew which type of soap they were using. “In terms of infection rates and sickness, we found absolutely no difference between anti-bacterial soap and regular soap,” said Dr Elaine Larson, Director of the Centre of Disciplinary Research on Anti-Microbial Resistance at Colombia University.
Antibacterial soap is not recommended for wide use, as there is a concern that germs will develop resistance and those using it will become lazy from using high-tech soaps. It is however recommended that antibacterial soap is to be used in certain high-risk areas such as food preparation and handling areas, in surgical conditions, treatment rooms, and clinical areas.
The risk, when using low-specification soaps, is that they can contain harsh chemicals that irritate the skin, leading to drying out, cracking, and redness which in turn can cause occupational dermatitis. This then leads to less regular hand washing for fear of exacerbating the problem and hand hygiene levels deteriorate, hence the importance of using a good quality mild soap.
| Alcohol-based | Alcohol-free | |
|---|---|---|
| Kills 99.9 percent of germs and bacteria | Y | Y |
| Fragrance-free | N | Y |
| Flammable | Y | N |
| Irritates skin/causes cracking | Y | N |
| Non-damaging to floors and other surfaces | Y | N |
| Extended persistency | N | Y |
| Breaks through dirt | N | Y |
| Recognised by the CDC and WHO | Y | N |
| Antiseptic (can be applied to wounds) | N | Y |
| Organic compound | N | Y |
| Imbedded moisturiser | N | Y |
| More cost effective | N | Y |
| Leaves residue after use | Y | N |
Examples of further research findings for using soaps can be reviewed within the below link for interest only: https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm378393.htm
The Centers for Disease Control and Prevention (CDC) in the USA says that washing hands with soap and water is the best way to reduce the number of microbes on them in most situations.
If soap and water are not available, it is recommended to use an alcohol-based hand sanitiser that contains at least 60 percent alcohol as the active ingredient and use enough to cover all surfaces of the hands and fingers to achieve effective disinfection. The average hand sanitiser contains about 62 percent alcohol.
The main two types of soap dispensers are safe, sealed cartridge systems and bulk fill or refillable dispensers, and it is really important to understand why one is so much more hygienic than the other.
We wash our hands with soap to kill germs and bacteria, however, if we are using soap from a bulk fill or refillable soap dispenser, we could be washing our hands with contaminated soap as bulk fill soap dispensers are a breeding ground for bacteria and are often inadequately cleaned. The issue is you can’t always see the harmful germs and bacteria, but they can result in the risk of germs spreading.
Refillable bulk dispensers can leave hands with 25 times more bacteria after washing. Once the lid is removed and refilled with soap, airborne germs and bacteria can enter the reservoir and contaminate the soap. Dispensers are rarely cleaned and filled correctly, and there is an increased risk of spreading germs and bacteria by washing hands with contaminated soap.
There are typically more bacteria in a bulk filled soap dispenser than in a toilet in the same bathroom; the CDC warns to not add soap to a partially empty soap dispenser. This practice of topping off dispensers can lead to bacterial contamination of soap.
The safe alternative to bulk fill dispensers is hygienically sealed cartridge systems, which are ultrasonically airtight being free from complete air and gases for maximum hygiene.
We often say that hand washing is the key to preventing the spread of illness. But wet hands increase the risk of transmitting bacteria, “so drying is an equally important step in prevention,” says urgent care specialist Theresa Lash-Ritter, MD.
Lots of research has focused on handwashing and hand drying techniques. In one study, microbiologists compared jet air dryers with warm air dryers and paper towels. What they found was disturbing:
The way each method works helps to explain the results.
Drying your hands with paper towels not only dries them faster, but the friction also dislodges bacteria to leave them cleaner.
The CDC recommends the following method:
See the diagram in this article titled ‘How to wash your hands effectively’.
If soap and water are not accessible, hand sanitisers that contain at least 60 percent alcohol (WHO guidance recommends a minimum of 60 percent compliant with BS EN 1500:2013) can be used, but do note they won’t clean visible dirt or grease, they can’t kill all germs and they can’t remove harmful chemicals. For effective disinfection, it is advisable to cover all surfaces of the hands and fingers.
There are several reasons why religious and cultural issues should be considered when dealing with the topic of hand hygiene and planning a strategy to promote it in healthcare settings.
Alcohol-free hand sanitisers entered the market to address the concerns and complaints that stemmed from the use of gels. In many ways, they have succeeded. Typically, these solutions are much easier on the hands and pose much less of a threat in cases of accidental ingestion and also pose a lesser potential as a fire hazard and are non-damaging to surfaces.
One other clear benefit is the extended persistence that occurs. The product’s ability to kill bacteria ends once the product has dried on the skin whereas the benzalkonium chloride-based low alcohol-free products continue to provide protection well after the solution has dried.
One possible drawback with the alcohol-free solutions is that they most often come in the form of foam. While this usually results in a more pleasing experience for the user (as opposed to gels), it does require a special foaming mechanism in the dispenser, often making converting from a non-foaming system cost prohibitive, as it could require new hardware to be installed.
Despite some clear benefits, alcohol-free based products have yet to gain real traction in the health market. Alcohol-based gels continue to be favoured by health organisations and are therefore seen as a more credible solution by many in the field. It’s not that these organisations don’t recognise the effectiveness of benzalkonium chloride-based solutions, however, the term “alcohol-free” could apply to any number of products on the market. (It’s a broad term that makes it impossible for agencies like the FDA and the WHO to endorse.)
Because both types of products do more or less the same job in killing harmful microbes, choosing the right product is a matter of assessing your needs against your environment, budget, and personal preference.
For example, if you work in a school, care home, a mental health hospital, or manufacturing workplace, an alcohol-free system would most likely provide you the most peace of mind and protection from ingestion or fire. If you work in a hospital that requires you to follow strict guidelines set by the NHS, you may need to go with an alcohol-based gel.
Whatever your needs, having an effective hand sanitiser as part of your preventative defence against illness and disease is a crucial part of a healthy environment.
Visit this BHTA page and search for “Decontamination and Infection Prevention” to find a list of reputable manufacturers and suppliers.
This article was put together by industry experts at the BHTA.
When you buy the equipment that is right for you, it can make a real difference to your quality of life, giving you freedom and independence. Whatever you need, this step-by-step guide is designed to help you make that right choice.
You need to be sure about what you need. There may well be so much choice out there that the right product for you may not be obvious. So, take advice, and, if you can, try before you buy. If you need professional help, contact your doctor, who may refer you to an occupational therapist or, for certain equipment, recommend a physiotherapist or speech therapist.
You need to know where to buy. Again, you’ll be spoilt for choice! You can find products in retail shops and stores as well as via mail order and the internet. If you are buying from the internet or via mail order, remember that whilst the prices may be keen, you can’t try before you buy or discuss your requirements face to face. There are two useful website links which can spell out your rights on distance selling in this article.
Many retailers are members of the British Healthcare Trades Association (BHTA), specialists in what they do, which means that you can buy with confidence because they are governed by their Code of Practice, the only one in this industry to be approved by The Chartered Trading Standards Institute.
Wherever you choose, try to have someone with you, like a friend or relative, and do test and try the equipment before committing yourself. BHTA members will guide you through the selection process looking at your current and future needs.
There are consumer exhibitions and shows throughout the year like Naidex, Kidz to Adultz, and Mobility Roadshow, where you can see and compare new products, and get the information you need to make an informed choice. See upcoming exhibitions here.
You need to know how much to pay. It makes sense to spend some time whether you need something as straightforward as a walking stick or a mobility scooter, spending a few pounds or investing thousands. You need real value for money: price is obviously part of it but so are the quality of service, the assessment of your needs, the guarantees, and warranties. Make sure that you understand the terms and conditions and the cancellation period (if there is one), should you change your mind or have second thoughts.
If you are disabled, you may not have to pay VAT, so check when you are buying. You may even get equipment free from your local council if you are eligible. A scheme runs in some parts of the country where you can get a voucher or prescription to redeem at an accredited retailer. It could also be worth your while contacting your local council or NHS trust, as they might have schemes to help. Your local BHTA retailer will guide you through the process.
Unfortunately, sometimes things do go wrong. Hopefully, with common sense and goodwill, matters can be sorted out amicably to everyone’s satisfaction before resorting to the law.
If you have bought from a BHTA member company – and there are over 400 member companies in the UK – you have the reassurance of the Code of Practice. All companies adhere to the code, which rigorously upholds your interests. It is the only one in the industry to be approved by the Chartered Trading Standards Institute. See a copy of the Code of Practice here.
If the company involved is not a BHTA member, you should contact your local Citizens Advice Bureau through www.citizensadvice.org.uk or phone 03454 04 05 06 (03454 04 05 05 Welsh language).
These are some of the organisations which provide information and advice.
Which?: Impartial advice and in-depth reviews.
Grants: Grants are available through local authorities for house adaptations and equipment. The main sources are Disabled Facilities Grant (DFGs) in England, Wales, and Northern Ireland or an Equipment and Adaptations Grant in Scotland. You must apply before buying equipment or starting any work.
DFGs are available to disabled people who own or rent their home. They can also be paid to landlords on behalf of tenants. The grant is means-tested, so the amount paid depends on your income and savings. The authority pays the grant but has to consult the social services department to find out if you need the adaptation or equipment and whether it will be appropriate for you.
The whole process can take some months. DFGs may be mandatory or discretionary. If the work is essential for you to be able to move around your home, you will be considered for a mandatory grant. You may qualify for a grant if, for example, your disability makes climbing the stairs virtually impossible and if you need the stairs to reach an essential facility such as a bathroom.
At the time of publishing this article, the latest information about grants and repair assistance is available at the following web addresses:
Living Made Easy: Offering clear, practical advice, this is a website that lets you read reviews of products and add your own comments.
No vehicle performs to its full potential without an efficient fuel system. The batteries fitted to electrically powered wheelchairs and scooters act as their fuel tanks and should be charged up and well maintained accordingly.
If your vehicle has gel batteries (most powered wheelchairs):
Gel battery performance improves once the battery has been cycled (discharged and recharged) 15-20 times. This break-in period is necessary to fully activate the battery for maximum performance and longevity. Thus, range and running time of your mobility device could initially increase with use.
If your vehicle has sealed lead-acid batteries (most scooters):
Whatever type of battery your vehicle has:
Occasionally, depending on many factors, batteries will need replacing after 12 months. More commonly, they will still be going strong after two or more years. As they grow older, their capacity reduces. It is time to replace them when you find that the battery gauge on your vehicle shows a low state of charge after your day’s use.
Weight of the vehicle or user, ambient temperature, state of battery charge, tyre pressure and terrain can all affect the range of a battery. If the temperature ranges outside of our yearly averages, i.e. above 35 degrees Celsius and below freezing, this will affect the range of the battery. If the battery’s “state of charge” is low, then consequently the battery capacity will be low.
You also need to know that:
Please note: The advice in this leaflet does not cover wet (old type, open-cell) batteries. They are very rare these days.
We acknowledge the help and assistance by Matthew Major (MK Battery) in creating this advisory article.
Mobility vehicles can improve your independence and lifestyle, enabling you to travel from your home, around your local community, and further afield.
The best way to ensure you make the right decision is to see and try a wide range of models from different manufacturers. You should first contact a local BHTA retailer and visit their local showrooms.
Here, you can see a number of models and make proper comparisons of size, comfort, and handling. You will also meet and get to know their staff and your backup team. If you cannot visit, then book a home demonstration, and try the different products in and around your own home. Give yourself time and try to avoid rush decisions.
Today, it is increasingly common to see a scooter or powerchair being used by people of all ages and abilities. People have now found out that these mobility vehicles are popular because without them they would be housebound or restricted to only very limited distances and that they are easy to control, economical to keep, and actually pretty good fun!
However, deciding on which model to see and which company to buy from is very important and can be difficult. You need to know that the product is suitable for all your needs and that the company is a qualified and experienced supplier. You need to know that they will look after you and your vehicle, now and in the future.
This is why the BHTA has produced this guide to help you choose the best combination of product and supplier, helping you to make an informed choice and decision.
Points to consider:
If away on holiday, you can find a list of BHTA members on our website should you need some help in the UK. Always look for the BHTA and Chartered Trading Standards Institute logo as a sign you are dealing with an approved member.
If you are travelling away from home in the UK and experience a fault or breakdown with your NHS-provided wheelchair, the National Wheelchair Managers Forum has a helpful leaflet called ‘Right to travel UK’ with important information about the support available to wheelchair users.
There are many variations of scooter, offering differing features to suit you, the environment you live in, and the terrain you wish to cover. Here are some questions to discuss with your local BHTA retailer when considering your options:
The models offered come in many styles: the smaller offering easy manoeuvrability, and portability, but often with smaller wheels which will not go up kerbs or over rough ground. Small batteries restrict range (possibly down as low as 10 miles), however, they may be better for indoor or short journeys. BHTA members are there to guide you through the process and make sure all your questions are covered and offer you reassurance.
Note that dismounting and mounting kerbs with any mobility vehicle can be very bouncy, and for some people can be uncomfortable, but with the increased availability of dropped kerbs and pedestrian areas, you should find the need for kerb climbing less necessary.
Powerchairs are usually more difficult to select than scooters. Most of the aspects you would consider when buying a scooter still apply, but generally a powerchair user has more limitations to their personal mobility and will probably be using their vehicle more regularly, often all day, and may depend on it in their home and outside. Comfort and support are essential, and battery range is important if using all day.
Points to ask:
Once you have decided which mobility vehicle is right for you and made an informed purchase, further information about the safe use of electric scooters and wheelchairs can be found in the BHTA article ‘Using electric scooters and wheelchairs: A Highway Code for users’.
Buying a second-hand scooter or wheelchair can be as difficult as buying a second-hand car. But it is here that you will reduce the dangers if you buy from a BHTA retailer.
All of our BHTA retailers are keen to provide you with proper training to help you be in proper control and at ease with your newly found independence. So, ask them to accompany you in and around your home and out to your local shops and venues. Your BHTA retailer will want you to feel confident so that you get the most pleasure and use from your new product.
All BHTA mobility retailers are encouraged to take part in Driving Mobility’s Powered Wheelchair and Mobility Scooter (PWMS) Retailer Training Scheme. This scheme, which is supported by the Department for Transport, provides customer assessment and safety training for retailers of mobility scooters and powered wheelchairs.
Looking after and regularly charging your vehicle will increase its reliability and reduce its running costs. You must always read your owner’s manual and take particular note about how to charge the batteries. Battery charging uses about the same electricity as a 100-watt light bulb, so it won’t eat you out of house and home.
For further information see the BHTA article ‘Getting more from your battery’.
For more information about the safe practices for use, maintenance, and disposal of lithium batteries, read the BHTA’s ‘Lithium battery safety guidance’.
Before buying a mobility vehicle, there are some points to be aware of to ensure that your equipment is stored and charged safely.
Battery-powered mobility scooters and wheelchairs pose a fire risk if they are not stored and charged correctly and safely. This is because the batteries themselves are flammable, so it’s paramount you follow safety guidelines to reduce any fire risks.
Battery-powered mobility scooters and wheelchairs should be stored in a safe place – preferably in a separate room – and away from fire escape routes. For example, your mobility vehicle should not be stored near a door. This is so that the vehicle does not obstruct any exit routes in the case of a fire. Also, if your vehicle catches fire near an escape route, this could affect the exit.
To safely charge your mobility vehicle’s battery, this should be done in a specially designated, well-ventilated area. You should also charge the battery during the daytime, so that if something goes wrong with the battery and there’s a fire, someone will be awake to dial 999.
Further information about the safe storage and charging of battery-powered mobility vehicles can be found in the National Fire Chiefs Council ‘Mobility Scooter Guidance for Residential Buildings’ guidance.
Your BHTA mobility retailer will always discuss the long-term needs of you and your vehicle. After years of extensive design and development these products have become more reliable and durable, and you should enjoy independence without worry. However, you must appreciate that with time, as with any mechanical product, components can go wrong.
It is at these times it is most important that you have taken your local BHTA mobility retailers’ advice on regular servicing plans, extended guarantees, and policies. If you are unfortunate enough to break down, you will realise why it was so important that you have a BHTA mobility retailer supply your mobility vehicle supported by factory-trained and qualified service engineers; they will get you back on the road quickly and efficiently.
Looking after your mobility vehicle properly will help you ensure trouble-free mobility. However, just like a car, you should expect to incur some running expenses for servicing and new batteries, for example.
So, we recommend putting a little aside each week to cover maintenance costs, or, alternatively, investigating extended warranties, service contracts and insurance. We hope you enjoy your newly found freedom.
These are some of the organisations which provide useful information and advice.
Driving Mobility is a network of 20 independent organisations covering England, Scotland, Wales, and Northern Ireland, which offers professional, high-quality information, advice, and assessment to people who need to gain or retain independence through mobility.
Telephone: 0800 559 3636
Motability is a scheme that lets you lease a mobility scooter, powered wheelchair, or car using your benefits. It also runs Motability One Big Day events where you can see and try out equipment.
Telephone: 0300 456 4566
Textphone: 0300 037 0100
If your local shopping centre or town centre has a Shopmobility Scheme, you can hire a scooter from it. Find out more from The National Federation of Shopmobility.
Telephone: 01933 229644
Publish independent test reviews on 10 smaller scooters on its subscription website.
Remember to always look for the BHTA and Approved Code Trading Standards logo to get the support and advice you need to make the right choice.
Need a wheelchair or mobility scooter? Not sure where to go and how to get one? Do you know your options?
When you find yourself or someone you know requiring a wheelchair, mobility scooter, or powered wheelchair then you should be talking to your local BHTA member retailer.
Dealing with a lack of mobility, whether due to an ongoing, chronic illness, or to a sudden incident, can be a confusing and stressful time. We all see manual and powered wheelchairs and mobility scooters being used, but where do they come from? How do you get one? Until you find yourself in a situation of needing one, it’s not something most people think about.
The wheelchair may be needed full time to get around the house, or to work, which may be a different model from something that may be used occasionally for trips to the doctors or for visiting friends where you may need assistance.
You can ask your GP for a referral to your local NHS wheelchair service if you are having mobility issues. They will discuss your situation with you and may provide an assessment for your needs. If they determine that you require a wheelchair, and you meet their criteria, they will offer to provide you with one. Wheelchair services provide both manual and powered wheelchairs but do not currently provide mobility scooters.
You may have an option to request a voucher, or to use a personal wheelchair budget (PWB), which can be used to purchase a chair from a mobility retailer if you want a higher specification or options that they cannot provide.
Sometimes you may require a wheelchair temporarily, whilst you rehabilitate, or while awaiting delivery of an NHS wheelchair. The British Red Cross in your area will usually have wheelchairs available for temporary use.
You can also contact your local BHTA Member retailer, which may have different types of wheelchairs available for temporary hire.
If you do not qualify for a wheelchair through NHS wheelchair services, or simply wish to purchase your own wheelchair or a mobility scooter, you can contact a BHTA-registered mobility retailer.
BHTA members across the UK offer mobility products and many independent living aids to enhance your life and keep you independent at home and outdoors. They will guide you through a detailed assessment to ensure the product meets your current needs. The BHTA member retailer will discuss the model that will most suit your lifestyle and demonstrate this to ensure you are capable of controlling the mobility product in a safe environment before you head out on your adventures.
Once you have identified the correct model, the BHTA member retailer will be able to also advise you on other topics such as finance, insurance, and any extended warranty packages that are available.
All BHTA members sign up to a Code of Practice which is approved by the Chartered Trading Standards Institute. This ensures you are dealing with a company that will give you good advice, guide you in your discussion making and will not cold call you or use pressure selling techniques. A copy of the Code of Practice is available to download here.
Once you have had your assessment, agreed your needs, and purchased all you need, your local BHTA member retailer will set up your mobility product, carry out pre-delivery inspection, and ensure you know how to charge your vehicle so you are ready to get out and about, unless you opt to take it away with you from their showroom.
Having someone local for backup, aftersales, and servicing is important for your own peace of mind, so should you have any issues you have somewhere local to talk to and visit. The BHTA member retailer will have a wealth of experience about your product, and their engineers will be trained and experienced to assist you with any issues you may have with your product.
To find your nearest BHTA member retailer visit this page and put “mobility” in the search box.
If you are looking for a second-hand piece of equipment, check with your local BHTA member retailer, which will be able to advise you on availability and suitability for your needs.
If you need assistance with the funding of a mobility scooter or wheelchair, there are numerous charities that may be able to assist you, and many BHTA member companies will have links to these on their websites and will be able to give you advice when they carry out an assessment with you.
In some cases, people can use a portion of their Personal Independence Payment (PIP) allowance to lease a mobility vehicle through companies providing this option.
Some customers buy their mobility products via credit cards, bank personal loans, or finance that is available through a number of specialist companies that have packages designed to meet the needs of the mobility industry. With a variety of options available, it is worth discussing the best options that suit your situation with your local BHTA member retailer.
There are many things to consider when thinking about insurance for your new mobility vehicle or wheelchair. There are insurance companies that provide dedicated insurance policies for mobility products. Some home contents insurance policies will cover mobility products, but it is always important to check that the cover is right for you.
Your home cover may pay for a replacement product if stolen but does it cover you for personal injury and public liability, for example, should you accidentally cause any damage with your mobility product or have an accident?
Your BHTA member retailer can advise you of insurance companies that provide specific mobility policies.
Most wheelchairs and scooters when purchased new, come with a 12-month guarantee. Sometimes this may be longer, and there may be options for purchasing extended warranties and/or service and maintenance packages.
Your BHTA member retailer can discuss these options with you to help you make an informed decision about what’s best for you.
BHTA publishes a number of guidance articles to assist consumers when choosing a mobility product. The articles contain useful tips on buying safely to help guide you through the process and point out questions to ask and things to consider.
The British Healthcare Trades Association (BHTA) has published a helpful guide on using a tourniquet. This advice is about the haemorrhage control pathway following a catastrophic bleed. It also contains important information about the different methods of treating a catastrophic haemorrhage depending on the severity and location of the injury.
Since December 2019, people who access NHS wheelchair services in England now have a legal right to a personal wheelchair budget (PWB). A PWB is a resource available to support your choice of wheelchair, whether accessed within the NHS wheelchair service or utilising the funding they provide in the private sector. PWBs enable postural and mobility needs to be included in wider care planning and can support you to access a wider choice of wheelchair or accessories.
PWBs have replaced NHS wheelchair voucher scheme. They build on progress to offer personal health budgets (PHBs) to more groups of people and ensure people receive care that is right for them.
PWBs have been developed by NHS England’s Personalised Care Group to empower people and their families to have far greater control over their own care and break down barriers between health and social care.
Wheelchair services tend each to have their own criteria to be met to supply a person’s basic mobility needs. Thus, a chair that can get you around on level pavements and in your home may be what you are offered but may not give you full access to the lifestyle you seek.
The aim of PWBs is to give the option to be able to upgrade your basic mobility option to one with extras that meet your broader needs. The PWB will have the value of the basic chair as a starting point, and this can be supplemented from your PHB, from your social services personal budget, from educational funds, from charity funds, and/or from your own personal funds.
As one client observed: “The wheelchair service option on its own was like my mum picking my clothes for me, whereas the PWB process treated me as an individual. It helped me feel more independent.”
The NHS England website has various blogs on it showing different benefits that different clients have gained from the extra options that their PWB has offered. These have included seat-raiser options to help the client get up to eye level with standing people, electric powered leg-lifters to handle swelling of the feet, lighter weight chairs than on the basic offer, better quality cushions or other accessories, etc.
In many parts of England, you can take your PWB to a manufacturer or retailer and get the solution you need. This does have an element of postcode lottery to it, as the details depend on where you live and your local wheelchair service’s policies.
A note of caution, though: The wheelchair services often have contracts with manufacturers where the price is lower than on the high street, but the choice will be limited to what is on the contract. Also, your local service may wish to offer a refurbished chair that has been returned from another client. If what the service offers meets your need, that’s great, but if it does not you can go to the private sector to supplement what the wheelchair service has to offer or for the complete solution.
You would be advised to go to a company that is a BHTA member. The BHTA is the first trade body within the healthcare industry to have a code of practice overseen by the Chartered Trading Standards Institute (CTSI). All BHTA members adhere to the Code of Practice ensuring you get appropriate advice and guidance about products that you may need to maintain independent living.
The NHS England website is also an excellent resource to give you more information, including answers to frequently asked questions. A number of these have been condensed into this article:
With a personal wheelchair budget, you should expect to have:
The PWB model is for people who have been referred to, and meet the eligibility criteria of, their local NHS wheelchair service and receive a face-to-face assessment with a clinician. People who are already registered with the wheelchair service are eligible when they require a new wheelchair, either through a change in clinical needs or in the condition of their current chair.
Note: Local eligibility criteria for wheelchair prescription vary, and these variations still apply.
The amount will be based upon what it would cost the NHS to meet your assessed postural and mobility needs via your wheelchair service. (Note: The amount varies from service to service.)
For those who have additional health and social care needs, the PWB could be pooled with funding from other statutory services, such as your PHB, your social care personal budget or your education support. (This needs to be agreed by all services involved as meeting the person’s assessed needs and is cost effective.)
Yes. You can contribute to the cost of your wheelchair. You can also choose to access non-statutory funding that may be available via voluntary support or charitable organisations, both nationally and locally.
A PWB can be managed in the following ways:
Note: Your local wheelchair service may have limitations on various of these options, such as requiring you to use service-approved third-party providers.
PWBs will not be right for everyone. Once you have been found to be eligible for a wheelchair, your healthcare professional will discuss with you the options for how this can be provided. Everyone should have an assessment focused on the health and wellbeing outcomes and goals they wish to achieve and have the opportunity to have their wider needs considered.
Note: It may not be clinically appropriate for someone with rapidly changing, or very complex needs, to use their PWB outside the wheelchair service as regular adaptations and changes may be required which would be likely to require close monitoring and adjustment. They could, however, be offered a notional budget. Such decisions will be made on a case-by-case basis, rather than using set criteria that restrict people who have certain conditions or diagnoses from accessing the full range of options.
As part of the care and support planning process, the PWB will need to be agreed by the responsible clinician involved in your care and that the wheelchair chosen is the correct specification to meet your assessed clinical needs.
BHTA independent supplier members sign up to a Code of Practice that gives a level of accreditation to give you confidence that you are dealing with people able to make appropriate decisions about meeting the aims of your assessment.
No, in that PWBs do not change the duty on statutory services to assess a person’s needs for a wheelchair. A PWB is for the equipment only.
Yes. A third-party PWB and direct payment (where the money is spent outside the NHS) should include a contribution towards the repair and maintenance costs. If a notional budget is taken, repair and maintenance will be provided via the wheelchair service. If the notional budget includes contributions to the cost of extra features, such as a seat riser, then repair or replacement of these features may not be covered by the wheelchair service.
People who take a third-party PWB become the owner of the equipment, whereas wheelchairs accessed via a notional PWB remain the property of the NHS. Where there are multiple funding streams involved, the ownership of the wheelchair needs to be agreed locally on a case-by-case basis.
If you choose to use your PWB outside of the wheelchair service and your assessment indicates the clinical need for accessories (this could for example include specialist seating or pressure-relieving cushions), then the NHS has a duty to provide these either as part of the PWB, or via the wheelchair service.
NHS wheelchair service provision is accessed via a referral from a healthcare professional. This could be obtained through consultation with your GP or issued via a therapist that you work with.
We all come across items in our daily lives that are regulated by standards, even if we do not know it. Meeting standards leads to increased safety, better compatibility between items, and better practice.
In this article, we cover the hierarchy of standards across the world as they benefit us in the UK and reflect on their importance, with particular reference to medical devices and ultimately the safety of our customers, clients, and patients.
Most of us will have come across the BSI Kitemark™. The BSI Kitemark originated as the British Standards Mark in 1903 for use on tramway rails when standardisation reduced the number of rail sizes from 75 to five. Today the BSI Kitemark can be seen on hundreds of products from manhole covers to condoms, from security locks to fire extinguishers and riding helmets.
Having a BSI Kitemark associated with a product or service confirms that it conforms to a particular standard: each BSI Kitemark scheme involves a determination of conformity to the relevant standard or specification of the product and an assessment of the management system operated by the supplier. This symbol is one that is trusted across the UK, and indeed across the world.
So what are these standards that are being referred to?
A standard is an agreed way of doing something. It could be about making a product, managing a process, delivering a service, or supplying materials. Standards can cover a huge range of activities undertaken by organisations and used by their customers.
Standards are the distilled wisdom of people with expertise in their subject matter and who know the needs of the organisations they represent, such as manufacturers, sellers, buyers, customers, trade associations, users, or regulators.
BSI, in its role as the UK National Standards Body, has a portfolio that extends to more than 30,000 current standards. They are designed for voluntary use so it’s up to you – you’re not forced to follow a set of rules that make life harder for you, you’re offered ways to do your work better.
Standards are knowledge. They are powerful tools that can help drive innovation and increase productivity. They can make organisations more successful and people’s everyday lives easier, safer, and healthier.
As a result, standards share good ideas and solutions, technological know-how, and best management practices. They identify safety issues of products and services and make products compatible so that they fit and work well with each other. An example of the latter are the HDMI or USB ports on your computer.
There is a generally accepted hierarchy of standards, starting with the International Organization for Standardization (ISO*) being adopted worldwide, the European Committee for Standardization (CEN)’s EN standards being adopted across Europe, and national standards being created and adopted by individual countries (e.g. BS standards in Britain, under the auspices of the BSI (British Standards Institute)).
Some International standards will have been adopted (and ‘harmonised’) across the EU and also adopted in, say, the UK, and as a result will have the letters BS, as well as EN and ISO, in front of them.
The added bit of fun is that at each level, the adopting body can add its own foreword to make minor alterations to the standard, for their local jurisdiction.
*Notice that ISO’s acronym doesn’t match ISO’s name? It’s not meant to. “ISO” is derived from the Greek word isos (equal), so that it’s the same in all languages.
Standards are prepared by Technical Committees (TCs – e.g. ISO TC173 Assistive Products or CEN TC 293 Assistive Products and Accessibility). Each TC has its own field of operation (scope) within which a work programme of identified standards is developed and executed. TCs work on the basis of national participation by the ISO or CEN Members, where delegates represent their respective national points of view. This principle allows the TCs to take balanced decisions that reflect a wide consensus.
A Subcommittee (SC) can be established within a TC, in the case of large programmes of work. The real standards development is undertaken by Working Groups (WGs) where experts, nominated and appointed by the ISO or CEN country members, but speaking in a personal capacity, come together and develop a draft that will become the future standard. This reflects an embedded principle of ‘direct participation’ in the standardisation activities.
The aim of the WGs is to have a balance across potential stakeholders, from commercial providers, public sector, etc, through to end user.
Individual countries opt to be participating members of any committee, or observers (where in this case they do not have a vote), or decide not to participate at all. Each country that participates tends to have its own national ‘mirror’ group, which feeds back each country’s comments and votes to the TCs and thereby the WGs.
In addition to ‘normative’ (i.e. prescriptive) standards, some will be called Technical Reports (TR) or Technical Specifications (TS), and these are informative.
A number of these informative standards become updated to become normative standards, as the material in them has been shown to stand the test of time. In the UK, BSI also produces Publicly Available Specifications (PAS), which, with time, can move onto being BS (British Standard) versions.
Standards go through an iterative process on the road to final acceptance and publication. ISO tends to have more steps than CEN or BSI. The ISO steps are generally as follows, though often the Working Groups get permission to skip a step or two. The earliest stage is when a perceived need for a new standard, or revision of a standard, has been identified, and this goes out to international vote, at which stage it is called a NWIP (New Work Item Proposal). When approved by a minimum of 5 countries (who also have to put forward experts to work on the project), it becomes an AWI (Approved Work Item).
The document itself it may start as a WD (Working Draft) or as a CD (Committee Draft), which is put out for international comments and vote. The Working Group then works through the comments, and if the feeling is that these have been addressed, the next stage is a DIS (Draft International Standard – the European equivalent is prEN) (or else it goes back for another round of CD comments and voting).
At the DIS stage any technical concerns should have been addressed, so when this draft goes out for voting, any comments coming back should really be editorial, unless some technical issues had been overlooked. If everyone agrees technically with the DIS, then it can be agreed to go straight to publication (with any editorial corrections addressed), or else it goes for one more round of voting as an FDIS (Final Draft International Standard – the European equivalent is FprEN), after which with majority approval it can be published. The drafts from DIS onwards can be referenced and worked with in the public domain.
Most standards have to be purchased, and are available through the BSI shop. For the ISO standards, it is possible to download the Introduction, Scope, and Terms and Definitions, for each standard for free from the platform: https://www.iso.org/obp/ui
Medical devices are placed on the market with specific clinically-related claims. The manufacturer has to justify these claims and also show that the product is safe and fit for purpose. Testing to, and passing, recognised standards is part of this process. If the manufacturer claims that their product is a medical device, they have to have it CE/UKCA marked in the EU and Great Britain respectively.
The placement of a CE or UKCA mark, and the MD symbol, on the product and its packaging, indicate that the product has been assessed against these criteria and registered in the relevant marketplaces.
Testing to ISO standards is voluntary, but if a manufacturer chooses to take another route, they need to have strong justifications not to use a recognised published standard. Where a product is sold in the EU or Northern Ireland, and there is a harmonised EN standard, then it is appropriate that the standard be followed.
Outside the regulatory framework above, as a prescriber you are following better practice for client safety and product assurance if you select an item that has been tested to, and passed, one or more of these recognised standards, than if the product is selected on, say, purely price grounds. The price may be slightly higher, but you will have the peace of mind that the manufacturer has picked up the costs of product testing, and thereby that your client is protected.
While some standards cover product testing, others provide guidance to best clinical practice, as well. Over and above the latter standards, there are also other sources of guidelines, such as the BHTA range of guidance publications, the Posture and Mobility Group Best Practice Guidelines, and RESNA’s position papers, all of which are free to download from these respective organisations.
BSI, and the Working Groups, welcome all applications to become a standards maker: you only need to have relevant knowledge and experience, or to represent a relevant group of stakeholders such as BHTA.
Please get in contact with BSI via standardsmakers@bsigroup.com
Technical Committee: TC173 Assistive Products*
Sub-committees:
TC173 SC1 Wheelchairs, which has four active Working Groups
TC173 SC2 Classification and terminology
TC173 SC3 Aids for Ostomy and Incontinence
TC173 SC7 Assistive products for persons with impaired sensory functions
TC173 also has the following individual Working Groups:
Technical committee: TC293 Assistive Products and
Accessibility, which has a number of working groups:
Working Groups are disbanded when the standard they have been working on has been published, and they have nothing else currently on their work programme. TC293 Working Groups WG2, WG3, WG4, and WG8 are currently inactive for this reason.
CH 173 – ISO TC173 and TC293 Mirror Group
CH 173/1 – ISO TC173 SC1 and TC293 WG9 Mirror Group
*ISO TC173 has a website from which it is possible to link with some of the TC173 activities, and access documents which are in the public domain: https://committee.iso.org/home/tc173
This document was created in association with NHS Supply Chain and is endorsed by the Chartered Society of Physiotherapy.
View and download this guidance as a PDF here.
For years, the experience of patients trying to find the right walking aid has been a confusing one. Suppliers and manufacturers have described products in different ways, and the way patients are measured to find the right one for them has also differed.
To improve the experience for walking aid users and the professionals who support them, NHS Supply Chain has engaged with the British Healthcare Trades Association (BHTA) members, professional bodies and their members, suppliers and walking aid users to develop industry standard terminology, sizing criteria and ways of measuring patients.
NHS Supply Chain is asking everyone to adopt the first wrist crease as the initial measurement point, prior to using clinical reasoning and patient comfort in the final height decision.
The following terms and ranges have been agreed for implementation by NHS Supply Chain. Suppliers and distributors are being encouraged to adopt the same.
Width – Ultra Narrow, Narrow, Standard Width, Wide, and Extra Wide
Height – Small, Medium, Large, and Extra Large.
The agreed measurements of the above are detailed below.
| Ultra Narrow | ≤499mm |
| Narrow | 500mm – 550mm |
| Standard Width | 551mm – 600mm |
| Wide | 601mm – 650mm |
| Extra Wide | 651mm – no upper limit |
| Small | ≤649mm |
| Medium | 650mm – 849mm |
| Large | 850mm – 949mm |
| Extra Large | 950mm – no upper limit |
Where a product spans multiple height ranges then the naming convention would be the start and end bracket. For example, a product with a height of 720mm-1,010mm would be termed Medium-Extra Large.
An example product description would be: Double Adjustable Crutch, Medium-Large (650-900mm), SWL 160kg.
There are currently over 23 million households in the UK, many in buildings more than 50 years old and most of which contain steps. This isn’t a problem when you have no difficulty climbing stairs, but if – for whatever reason – even a couple of steps becomes a major barrier or physical hazard, your own home can suddenly quite seriously disable you.
When this happens, you are left with four choices: do nothing, all too quickly losing the ability to live independently in your own home; you can re-organise the house in order to live and sleep downstairs; you can move to a bungalow or ground floor flat; or you can install some form of domestic lift, such as a stairlift or a through-the-floor lift. This last option is likely to be the least distressing, the most practical, and financially prudent means of ensuring you retain as much independence as possible.
When installing a domestic lift, your first move should be to get an independent assessment of your daily living needs by a BHTA stairlift member. Occupational therapists (OTs) and other healthcare professionals can often offer independent advice, not only on potential access solutions, but also on the variety of grants and funding options that may be available to help with the cost, which will be financially means tested.
Independent Living Centres can also help. This discussion will help you to decide how best to solve your problems, and you’ll be in a much better position to get the support and facilities you need.
Domestic lifts, such as a stairlift or a through-the-floor lift, come in a variety of forms; your final choice ultimately depends on your own particular needs and situation. There is a misconception that many people think that stairlifts are fixed to the wall. All stairlifts are fixed to the stairs, not the wall.
Fixed stairlifts are powered mechanisms mounted on stair-fixed tracks, which follow the line of the stairwell (so can be either “straight” or “curved”). A majority of these are used by people who can walk but find stairs a problem; the user is normally seated during transfer, although some models allow you to perch or stand, which might be preferable if you have difficulty bending your knees.
There are also fixed stairlifts with a wheelchair platform, but although the platform usually folds up against the wall, they do take up a lot of room and many domestic stairwells may not be broad enough.
A through-floor or homelift may be ideal if you are able to stand or sit and come in compact or wheelchair accessible sizes.
Naturally, building work is involved to create the aperture for a lift, but your homelift provider will be able to take care of that for you. Homelifts are more expensive than some stairlifts.
Short rise lifts are ideal for coping with small changes in floor level – at a front step or in a split-level hallway – where there is insufficient space to put a ramp. Some structural work may be required to ensure that the main mechanism is sunk below ground level.
The value of a professional assessment by a local BHTA stairlift member cannot be over-emphasised, as there are lots of questions that need to be answered before you can proceed. For example:
Your physical condition could deteriorate, so it may be wiser to consider installing a through-the-floor lift so that, in the future, it can accommodate a wheelchair.
You need to take into consideration the home environment, not just in relation to the physical things like doors, bulkheads, and radiators, but also family members, pets, and visitors.
Make sure a stairlift covers the whole length of the staircase if you’re buying second-hand; one that covers 11 stairs in one house might only cover 10 in yours.
All installations should be carried out by a manufacturer-trained engineer. It is advisable not to use untrained staff for installation.
Check whether the company you’re dealing with is a member of the BHTA. All BHTA members commit to a Code of Practice, approved by the Chartered Trading Standards Institute. The code sets out the levels of service you can expect from the company.
Choosing the right stairlift will make a great deal of difference to your comfort and confidence in using it. There are various aspects to consider and products designed to suit different needs.
Stairlifts can be fitted to most properties. If you have a curved, spiral, or unusually shaped staircase it may be possible to install a more specialist product. Outdoor steps and stairs can also be accommodated. These come with water-resistant components and covers protecting them from the elements.
All manufacturers make lifts for straight stairs, so there are many models to choose from.
You might feel able to get off the lift and walk up the last few steps, but you need to decide if you are likely to be able to go on doing this. If you need to travel the entire way to the top of the staircase, you may need to consider a curved stairlift from the outset. Always seek advice from your stairlift installer if you are unsure of the right model for your application.
Curved stairlifts are made bespoke to the staircase and, in some cases, can even be fitted to spiral stairs.
You always have to think about how much room you need for your knees or feet to accommodate you on a stairlift in a seated position. It is worth talking to a specialist BHTA member, as there are variations between models and they can guide you through the assessment.
If there is a door close to the bottom of the stairs, the stairlift may have to travel across it. To avoid everyone using the door and stepping over the rail, most lifts have folding rails as an optional extra, which lift the rail up and out of the way. Changing the stairlift to the opposite side of the staircase may be another solution.
In most houses, there is enough space at the top and bottom of the stairs for getting on and off the lift comfortably. In some houses, you have to be careful not to bang your knees on radiators or other obstructions. Consider removing any obstructions (radiators may be re-sited or replaced with smaller models for convenience). Seek advice from your stairlift installer.
You can park the lift at the top or the bottom because you can send it back up or down the stairs once you have got off. Some curved lifts can also have intermediate park points.
If you use a wheelchair, you need to be able to transfer on and off a stairlift seat and to sit in it safely. If you cannot transfer, you will need to think about a stairlift with a wheelchair platform or a vertical lift.
Stairlifts need to be comfortable to sit on. All the models come with a safety belt that you should always use. If you have stiff limbs or difficulty bending your knees, it may be easier to choose a lift with a footrest you stand on and a perching stairlift, which has a small, high seat or ledge to give support during travel. You may consider a downward facing seat.
If other people use the stairs and you have a narrow hall and landing, you will probably need to fold the lift up when you are not using it. The armrests and footrests fold on all models with seats. The seats fold too on most models, although, on some, only the front section of the seat flips up.
How easy it will be to get on and off a stairlift is affected by the height of the seat and the amount of space in your hall and landing, so seek advice from your BHTA stairlift member company, which will recommend the best solution for you and your stairs.
As a guide, your minimum seat height should be the distance from the crease at the back of your knee to the floor. Some models have adjustable seat heights, and some will have a one size fits all.
All stairlifts with a seat have two armrests. All armrests lift up to fold back. These can be raised separately to assist you when transferring or standing up. This is particularly helpful if you are transferring across from a wheelchair.
Your BHTA specialist will give you helpful advice and user tips when carrying out an assessment.
Swivel seats help, because you can swing round to face away from the stairs and towards the landing. The swivel is operated by levers which are usually on the side and just below the seat cushion. The size and shape of these varies. Some manufacturers offer a powered swivel option.
Stairlifts usually have two controls – one to switch the power on and off, and one to make the lift move up or down. Most up/down controls are either operated by a joystick or pushbutton, dependent on the model.
On stairlifts the controls are usually on the armrest – either on the top or on the end; but make sure that it is not where you might accidentally switch it on when you are getting on or off the stairlift. This can be a problem if your hand slips easily or if you make involuntary movements.
On standing and perching lifts, the controls are on the guard rail or on the armrest – you can reach them when the seat is folded up. You do have to press the up/down control continuously while the lift is moving – if you don’t it will stop.
Most lifts are supplied with wall-mounted call and send switches at the top and bottom of the stairs. Some manufacturers and suppliers provide handheld and remote call and send switches with their lifts.
All stairlifts are supplied with a seat belt. Some are retractable belts, and some are lap straps. Most manufacturers also offer a harness option.
Diagnostic lamps or displays can guide you should the lift not operate correctly. This is especially helpful when contacting the service engineer. Many simple issues can be resolved over the phone saving on callouts.
The lift can be installed quickly if you are buying directly, using your own money. But it can take several months if you are waiting for a grant.
Installation itself is usually done in a day. You might not be able to use the stairs while the work is being done. Installation will need a power socket so that the stairlift can remain plugged in or wired directly to the spur socket and must remain switched on at all times.
Homelifts and vertical through-floor models will need building work, and this needs to be considered as part of the planning before installation.
If you buy a stairlift direct, the manufacturer or distributor will deliver and install it. This will include all electrical work and the removal of any obstructions on the stairway, such as a handrail. Ask the installer what alterations will be needed, and who will be responsible for them, including any making good.
The running rail for most stairlifts is fitted directly on to the stair treads, so holes have to be made through the carpets. Decorations are affected where the controls are fitted to the walls.
The installer will show you how to operate the stairlift and make sure that you can manage it and that you are comfortable on it. He/she should make any necessary adjustments. Make sure that your feet fit on to the footrest and that it is a comfortable distance from the seat.
You should be given written instructions and a telephone number to use if you have any queries or problems. It’s a good idea to stick the number on the lift.
Any stairlift should meet European Standard BS EN 81-40 as well as the relevant European CE marking. Through-the-floor lifts should meet British Standard BS5900, which covers the installation and the use of powered homelifts.
European Standard BS EN 81-40 requires a number of safety features:
A stairlift is one of the more significant pieces of equipment you are likely to buy to make your house easier to live in. If you do not have the funds yourself, there are different ways to access grants or other financial help.
Grants are available through local authorities for house adaptations and equipment. The main sources are: Disabled Facilities Grant (DFGs) in England, Wales, and Northern Ireland or an Equipment and Adaptations Grant in Scotland. You must apply before buying the stairlift and starting any work.
DFGs are available to disabled people who own or rent their home. They can also be paid to landlords on behalf of tenants. The grant is means-tested, so the amount paid depends on your income and savings. The authority pays the grant but has to consult the social services department to find out if you need the adaptation or equipment and whether it will be appropriate for you. The whole process can take some months and can be subject to a priority waiting list.
DFGs may be mandatory or discretionary. If the work is essential for you to be able to move around your home, you will be considered for a mandatory grant. You may qualify for a grant if your disability makes climbing the stairs virtually impossible and if you need the stairs to reach an essential facility such as a bathroom.
At the time of publishing this article, the latest information about grants and repair assistance is available at the following web addresses:
If you live in housing association property, you may be eligible for the grants described above. Alternatively, a grant can be paid to the housing association if you are assessed as needing an adaptation or equipment.
In England and Wales, grants are available through the Housing Corporation; in Scotland through Scottish Homes; and in Northern Ireland grants come direct from the Department of Environment, Northern Ireland.
If you do not qualify for a grant, or it does not cover the full cost of your stairlift, and you cannot afford the sum required, you might consider approaching social services for some assistance.
National and local fund-giving bodies and charities may be able to give you financial help. Local libraries have directories of these. The Disabled Living Foundation publishes a free fact sheet on sources of finance for disabled people.
You may not have to pay Valued Added Tax (VAT) if you are buying a lift for your own use or you may only have to pay a reduced VAT rate of five percent. You do not have to be registered disabled. The supplier will give you a form to complete if you are eligible.
All new lifts come with a minimum guarantee of 12 months. This covers the cost of parts, labour, and callouts. Most firms supplying second hand lifts give a six- or twelve-month guarantee. Beyond that, the main types of aftersales support are:
As recommended by British safety standards, it is imperative that your lift is serviced annually. This safety check is very important, as it can identify if the lift safety features are all working correctly, and bolts and fittings are tightened and checked.
This is generally an extension of the guarantee. The cost varies between companies and according to how many years you opt for. This cover includes parts, labour callouts, and servicing checks.
This is a cheaper alternative to an extended warranty. It may be the only option available for lifts bought second hand. You book a service, once a year. The cost covers labour, but you have to pay for any replacement parts.
If the lift breaks down and you don’t have a maintenance contract, you will need to call out the manufacturer, retailer, or a repair firm. Typical costs will be comparable to a plumber or electrician’s callout charge, excluding parts. Before taking on any type of maintenance contract, check what it includes and hours of callout availability.
Depending on where you live and how you buy your stairlift, you may be able to get help with servicing costs from your council, registered social landlord, or social services. This is dependent on local policies, but it is worth making enquiries before you enter into any service agreement. Check if you are required to pay for any maintenance work if the lift is supplied as part of a grant.
The warranties offered by stairlift firms cover the lift only for mechanical failure. If you want cover against accidental damage, and things like fire, theft, or flooding, you will need to take out insurance on the lift.
Insurance companies vary in whether they insure stairlifts under contents or buildings policies, or indeed at all. Always tell your insurance company when you are having a stairlift installed.
If your local authority is responsible for the stairlift and for servicing, it might also pay for insuring it.
Specialist insurers are able to give specific policies for stairlifts. Information on these can be acquired from your stairlift supplier.
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